SHM Converge Scientific Abstract ePoster Gallery-Can Financial Incentives to Residents Promote Early Hospital Discharges?

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This study examined whether financial incentives could encourage resident physicians to place discharge orders earlier in the day and improve hospital flow. High hospital occupancy contributes to emergency department boarding and patient risk, so the team tested a “discharge before noon” style intervention targeted at residents rather than attendings.<br /><br />During a 12-week intervention period (March 1–May 31, 2025), eight resident teaching teams reported the number of discharge orders placed before 12 PM and after 5 PM each weekday. To encourage participation, the team with the highest number of discharges by Friday each week received a $100 gift card. Discharges after 5 PM were also tracked to avoid incentivizing teams to keep stable patients hospitalized overnight. The intervention was compared with two control periods: March–May 2024 and December 2024–February 2025.<br /><br />The primary outcome was the percentage of discharge orders placed between midnight and noon versus noon and midnight. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission rates. The intervention significantly increased the proportion of earlier discharge orders to 42.8%, compared with 30.74% and 30.89% in the control periods (p<0.001). Importantly, there were no significant differences in LOS or 30-day readmissions.<br /><br />Resident surveys showed that 84.4% viewed hospital overcrowding as a patient safety issue. Residents reported that the gift cards helped team bonding and created friendly competition. Key barriers to early discharge included imaging delays, late consultant rounds, and complex social disposition planning.<br /><br />Overall, the pilot suggests that modest financial incentives can meaningfully shift resident discharge behavior without worsening LOS or readmission rates. The findings also highlight workflow barriers that future quality improvement efforts should address.

Asset Subtitle

Shu Zheng

Meta Tag

Author List Badr Samer, Christina Wang, Kathryn Haroldson, Samantha Shor, Shu Zheng

Category Research

Concept Incentives

Concept Hospital Discharge

Concept Early Discharge

Concept Discharge timing

Concept Resident Physician

Distinguished Non-Finalist

Presenter Organization Cooper University Hospital

Presenting Author Shu Zheng

Track Quality Improvement

Keywords

financial incentives

resident physicians

discharge orders

hospital flow

early discharge

patient safety

length of stay

30-day readmission

quality improvement

hospital overcrowding

Incentives

Hospital Discharge

Early Discharge

Discharge timing

Resident Physician