Mind the Gap: Analysis of the Timeline of Medical Readiness and Qualitative Review of Discharge Delays.

Introduction: Efficient discharges lead to decreased length of stay and improved hospital flow. An efficient discharge requires timely recognition of medical readiness for discharge (MRD) and effective preparation. The objective of this study was to better understand pediatric hospital medicine discharges by (1) analyzing the time of MRD and discharge throughout the day, (2) assessing the time from MRD to discharge, and (3) categorizing commonly identified discharge delays.

Methods: A retrospective chart review of pediatric hospital medicine patients with the diagnoses of asthma, "brief resolved unexplained event," hyperbilirubinemia, or "rule out sepsis neonates" was completed. MRD was determined by reviewing the patient's chart for completion of diagnosis-specific discharge criteria. MRD was compared to the time of discharge order and discharge. Delayed discharges were reviewed further to identify reasons for the delay.

Results: One hundred discharge events were analyzed - 25 from each of the 4 selected diagnoses. MRD occurred throughout the day (33% morning, 43% afternoon, 14% evening, and 10% night). The median time from MRD to discharge was 1.7 hours (0.5 hours from MRD to discharge order and 0.9 hours from order to discharge), with the longest MRD to discharge time in asthma patients. Forty percent of patients had a delayed discharge, and identified reasons for delays were further categorized.

Conclusions: MRD occurred throughout the day, suggesting the MRD to discharge time may be an informative metric of discharge efficiency. Next steps include developing forward-facing electronic health record alerts noting MRD for improved tracking and real-time communication and targeted interventions to address reasons for discharge delays.