SHM Converge Scientific Abstract ePoster Gallery-Dedicated Discharge Physician Assistant Improves Discharge Order Time

Pdf Summary

Discharge delays can worsen ED boarding and reduce bed availability. To address this, Brigham and Women’s Hospital piloted a Discharge/Admission Physician Assistant (DAP) role for inpatient medicine physician assistant teams in June 2022. A working group identified competing priorities, such as walk rounds and unexpected patient instability, as major causes of delayed discharges. In response, the team created a process in which a DAP PA identifies likely next-day discharges, prepares discharge materials, confirms transportation, and completes discharge orders and final discharge steps on the morning of discharge.<br /><br />The pilot began with PA champions and later expanded to rotate the full team to improve buy-in and sustain the workflow. A dashboard tracked rolling median discharge order time, the percentage of discharge orders placed by noon, and median discharge time. This allowed daily coaching and rapid feedback.<br /><br />Before the intervention, the median discharge order time was 1:08 PM. After implementation, DAP discharges accounted for 30% of team discharges, and the median discharge order time improved to 9:07 AM. All DAP patients had discharge orders placed before noon. The project also noted that 85–95% of discharge preparation was completed by the morning of discharge.<br /><br />The main conclusion was that assigning a dedicated discharge role successfully improved discharge timing and freed other providers to focus on patients not yet ready for discharge. Next steps include identifying barriers to before-noon discharge with nursing and care coordination teams and using daily root-cause review to continue improvement.

Asset Subtitle

Marissa R. Cauley

Meta Tag

Author List Marissa R. Cauley

Category Innovations

Concept Discharge Delay

Concept Discharge/Admission Physician Assistant

Concept Patient Flow

Concept Emergency Department Boarding Time

Concept Discharge timing

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Marissa R. Cauley

Track Quality Improvement

Keywords

discharge delays

ED boarding

bed availability

physician assistant

DAP role

inpatient medicine

discharge workflow

morning discharge

discharge orders

hospital efficiency

Discharge Delay

Discharge/Admission Physician Assistant

Patient Flow

Emergency Department Boarding Time

Discharge timing