Dr. Klein

Clinical question: Does a physician rounding style prioritizing discharging patients lead to earlier discharges or reduced length of stay (LOS)?

Background: Delayed discharges can adversely affect patient flow throughout the hospital, leading to delays of care, increased LOS, higher cost, and potentially increased mortality. Prioritizing discharges by a specific time has shown mixed results in prior studies. There have been no previous randomized studies to assess the efficacy of a rounding style prioritizing discharges.

Study design: Prospective, multicenter, randomized, controlled trial

Setting: Three large academic hospitals in the U.S.

Synopsis: A total of 61 physicians were randomized to one of two rounding styles over a period of approximately six months: (1) prioritizing discharging patients first as care allowed or (2) usual rounding practice. Physicians could break protocol if needed for patient care purposes. Physicians completed daily surveys, which included questions regarding rounding styles. There was no significant difference in discharge time (15:22 ±2h:50min versus 15:21 ±2h:50min, P=0.45) or LOS (75h versus 78h, P=0.42) between physicians who prioritized discharges versus usual rounding, respectively. In secondary analyses using a self-reported rounding style rather than group randomization, there was also no significant difference in LOS (P=0.30). The results suggest prioritizing discharges may not improve hospital throughput. Limitations include contamination of study arms (some clinicians do prioritize discharge patients as their usual practice style) and generalizability to other health care systems.

Bottom line: A rounding style that prioritized discharging patients first did not result in significantly earlier discharges or reduced LOS.

Citation: Burden M, et al. Discharge in the a.m.: A randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay. J Hosp Med. 2023;18(4):302-15.

Dr. Klein is a hospital medicine attending physician at Maine Medicine Center, Portland, Maine, and an assistant professor at Tufts University School of Medicine, Boston.