Timely Discharge Factors within a Neurosciences Hospital Department

Discharge before noon;patient flow;timely discharges;Healthcare Leadership & Management

Hawley, Gina RayBurnham, Gilbert M. ;

Johns Hopkins University

关键词: Discharge before noon;    patient flow;    timely discharges;    Healthcare Leadership & Management;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/37036/HAWLEY-DISSERTATION-2014.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Objective: To understand which system-wide and/or patient-related factors are associated with patients being discharged earlier (before 12PM) from a Neurosciences inpatient department in comparison to those patients discharged 12PM and after. Background: Hospital beds are a scarce resource, thus efficiency of patient discharge and providing bed capacity is of utmost importance. Issues such as Emergency Department (ED) overcrowding, long wait times, and high hospital occupancies are causes for concern with patients waiting to be admitted to or transferred throughout the hospital. Late discharges further agitate patient flow by causing bottlenecks and the inability to move patients through the hospital in an efficient manner.1,2 Understanding what factors are associated with those patients discharged earlier in the day can assist hospital staff and administrators by concentrating on those factors and ensuring earlier discharges.Data: Data were obtained from various sources including Datamart, the main hospital data system, which contains various information fields such as patient length of stay (LOS), Intensive Care Unit (ICU) days, discharge locations, hospital occupancy, and operating room (OR) cases. Neurosciences Patient Flow, Rapid Response Team (RRT), and Workforce Management (WFM) datasets were also used. Analysis of data was conducted through STATA 11.0.Setting: Large, urban academic medical center. Neurosciences ICU and acute units compromised of 88 beds and over 4300 discharges annually.Study Design: This study was a retrospective analysis of inpatients that have been discharged from a Neurosciences ICU and/or acute inpatient unit between July 2010 and June 2013 (n=12,733). Exploratory analyses and predictive modeling using multiple logistic regression (with the outcome variables being discharge before 12PM or 12PM and after) were utilized to examine which independent variables have a significant association with the earlier discharge time before noon. A smaller data subset (n=4,397) examining the additional effect of discharge order time on the day of discharge was also analyzed.Results: In the main model, 11 out of 32 system-wide and patient-related factors (34%) were significantly associated with patients being discharged before 12PM, or 12PM and after. Significant system-wide factors included count of Registered Nurses (RN) on unit (odds ratio (OR) 1.32; 95% confidence interval (CI), 1.24-1.40), count of RN trainees on unit (OR .71; 95% CI, 0.64-0.794), and transfers into unit during the day of discharge (OR 1.06; 95% CI, 1.02, 1.096), along with patient-related factors such as patient being discharged to an on-site acute rehab facility (OR 0.15; 95% CI, 0.07-0.33), discharged against medical advice (AMA) (OR 3.66; 95% CI, 0.174-7.63), and patient from out of state (OR 1.28; 95% CI 1.09-1.51). In the data subset with discharge order time, 8 out of 32 factors (25%) were significant. In addition to the variables above, patient-related factors such as being discharged to an external acute rehab facility (OR 1.70; 95% CI, 1.20-2.43), discharge orders being completed between 6:00-7:59AM (OR 2.23; 95% CI, 1.57-3.16), and between 10:00-11:59AM (OR 0.18; 95% CI, 0.156-0.218) were also significant in the discharge order data subset. Fifty-five percent of system-wide factors were significant in either or both models, while only twenty-nine percent of patient-related factors were significant. Ten interaction, or combination, factors were significant in the main model and discharge order time data subset. Sixty percent of interaction variables had LOS as one of the modifying factors.Conclusion: Several system-wide and/or patient-related factors were significant in both models. While some patient-related factors has significant association (such as certain post-discharge locations or LOS), fifty-five percent of system-wide factors had a significant impact on patients being discharged before 12PM, indicating that system-wide factors can influence patients being discharged earlier in the day.