SHM Converge Scientific Abstract ePoster Gallery-Analyzing Monday Discharges to Identify Lost Opportunities for Weekend Discharge in Adult Patients Admitted to the Hospital Medicine Service

Analyzing Monday Discharges to Identify Lost Opportunities for Weekend Discharge in Adult Patients Admitted to the Hospital Medicine Service

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This retrospective chart review examined adult general medicine patients discharged on Monday at a 1100-bed urban academic tertiary care center to identify missed opportunities for weekend discharge.<br /><br />Among 246 Monday discharges between February 1 and April 30, 2021, 44 patients were excluded for leaving against medical advice, being readmitted within 24 hours, or dying on Monday. Of the remaining 202 patients, 81 (40%) were judged medically stable for discharge during the prior weekend. These delayed discharges accounted for 245 of 1147 inpatient days (21.4%), with an average of 3.0 excess days per patient.<br /><br />The most common reasons for delay were:<br />- Facility placement (33%)<br />- Starting or restarting home services/equipment (25%)<br />- Patient or caregiver disagreement with discharge (15%)<br /><br />Facility placement and patient/caregiver disagreement caused the longest delays, averaging 4.1 and 3.7 excess days, respectively. Other delay causes included bed availability, home health aide needs, insurance authorization, home oxygen, consults, imaging/procedures, and other medical or logistical barriers.<br /><br />Weekend staffing transitions also mattered: discharge delays were more common when patients were cared for by a new weekend attending versus continuity with the weekday attending (47% vs 26%, p=0.01). Discharge delay rates were similar on resident teaching and non-teaching services.<br /><br />The authors concluded that over one-third of Monday discharges represented missed weekend discharge opportunities. They suggest future quality improvement efforts should focus on earlier initiation of facility placement and home services, better patient/caregiver communication about discharge readiness, and potentially staffing or handoff changes to improve weekend throughput.

Asset Subtitle

Margaret Shyu

Meta Tag

Author List Andrew S. Dunn, Anne S. Linker, Justine Anderson, Margaret Shyu, Sophia Golec, Vinh-Tung P. Nguyen

Category Research

Concept Monday Discharge

Concept Delayed Discharge

Concept Adult General Medicine Patient

Concept Medical Stability

Concept Excess Hospital Day

Distinguished Non-Finalist

Presenter Organization Stanford University

Presenting Author Margaret Shyu

Track Quality Improvement

Keywords

weekend discharge

missed discharge opportunities

general medicine

retrospective chart review

hospital discharge delay

facility placement

home services

patient caregiver disagreement

weekend staffing transitions

quality improvement

Monday Discharge

Delayed Discharge

Adult General Medicine Patient

Medical Stability

Excess Hospital Day