In early 2011, NYU Langone Medical Center aimed to get 30% of its discharged patients out the door before noon in an effort to reduce bottlenecks and ease patient flow.
One year later, discharge-before-noon rates for the New York hospital's medicine service lagged far behind that target. Discharges were delayed because test results weren't ready or transportation hadn't been arranged. Residents were behind filling out discharge orders or patients and their families hadn't received post-discharge education. Some patients just wanted to stay for lunch.
“It seemed like the moons had to be aligned to get patients out by noon,” said Dr. Katherine Hochman, director of the hospitalist program and associate chair for quality at NYU Langone. “To me, it was a marker that everyone was not on the same page.”
Discharging patients late in the day is linked to emergency-department overcrowding, longer lengths of stay and lower patient-satisfaction scores. Like 791-bed NYU Langone, many hospitals are looking at setting early discharge targets as a way to avoid gridlock and make it easier for discharged patients to access same-day services such as primary-care appointments and home health.