Discharge Rounds: Implementation of a Targeted Intervention for Improving Patient Throughput on an Inpatient Medical Teaching Service

Objectives Patient throughput and early discharges are important for decreasing emergency department wait times and creating available beds for new hospital admissions. The educational schedule of internal medicine trainees can interfere with timely discharges, but targeted interventions can help residents meet the hospital's patient flow needs. Our training program instituted daily morning discharge rounds on the inpatient service, requiring each team to prepare potential discharges 1day ahead and prioritizing these discharges the next day. Methods We conducted a retrospective, pre-post analysis 1month before and 3months after implementation in August 2013 to assess discharge order entry times, the proportion of discharges before 11:00am, and hospital departure times. Results One month post-implementation, discharge orders were entered 59minutes earlier (from 1:07pm to 12:08pm; P=0.001), the percentage of pre-11:00am discharges increased from 21% to 39% (P<0.01), and patients departed the hospital 50minutes earlier (from 3:21pm to 2:31pm; P=0.005). These effects, however, returned to pre-implementation times during the subsequent 2months. Conclusions A targeted intervention can significantly improve early discharges and should be replicable at other academic medical centers. Reinforcement is needed for these gains to be sustainable, however.