Implementing and Evaluating a DBN Initiative in a Large Tertiary Care Urban Hospital
Clinical question: What is the impact of implementing discharge before noon (DBN) initiatives on discharge time and other factors such as length of stay (LOS), 30-day readmission, and ED boarding time?
Background: Discharging clinically ready patients before noon on their discharge day may influence the quality of the discharge process, ED boarding times, and LOS.
Study design: Retrospective pre/post-intervention analysis
Setting: Maimonides Medical Center’s hospital medicine units in Brooklyn, N.Y.
Synopsis: Initiatives aimed at facilitating DBN were refined or added during this pilot project, including incorporating the DBN process into daily rounds, an electronic tracking system, transportation when appropriate, expedited processing of laboratory tests, and physical therapy consults. Kaplan-Meier estimates and a log-rank test characterized and compared the discharge time probabilities between the pre- and post-intervention groups. Log-logistic accelerated failure time (AFT) analysis assessed the influence of DBN on discharge time. Secondary analyses examined the impact of DBN on LOS and 30-day readmission due to any cause. Post-intervention, DBNs increased from 5.0% to 11.4% (P <0.001), and overall discharge times were 41.5% earlier (P <0.001). DBN as an independent factor was not associated with LOS or subsequent readmissions within 30 days for any cause. Despite an increase in the percentage of patients admitted during the daytime (8:00 a.m. to 5:00 p.m.), the median ED boarding time increased by 41 minutes in the post-intervention group (P <0.001). The study was conducted in a single medical center, which limits generalizability.
Bottom line: DBN initiatives were associated with an increased percentage of patients discharged before noon but did not reduce ED boarding time or readmissions at 30 days.
Citation: Kausar K, et al. Implementing and evaluating a discharge before noon initiative in a large tertiary care urban hospital. Jt Comm J Qual Patient Saf. 2024;50(2):127-38.
Dr. Alcaraz Alvarez
Dr. Alcaraz Alvarez is a hospitalist in the division of hospital medicine at the Mount Sinai Health System and an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.