SHM Converge Scientific Abstract ePoster Gallery-Internal Medicine Subspecialty Fellow Perspective of Early Discharge at an Academic Medical Center

Pdf Summary

This study surveyed internal medicine subspecialty fellows at a large academic medical center to understand their views on early discharge. The authors note that delayed discharge can worsen emergency department overcrowding, increase length of stay, and reduce patient flow, while academic centers may face added barriers when consultant recommendations are needed before discharge.<br /><br />An anonymous 11-question online survey was sent to 107 fellows, and 55 responded (51% response rate). About one-quarter had previously worked as hospitalist attendings. More than half of respondents said their fellowship orientation emphasized early discharge as an important financial metric. Most fellows reported that they prioritize potential discharges first during rounds, and many said their attendings also prioritize early rounding for patients who may leave the hospital. <br /><br />However, fellows identified several barriers. The most common were unexpected lab or imaging results and changes in clinical status that extend hospitalization. Less than half reported that their specialty has a clear process for quickly approving discharge recommendations. Only 26% agreed that delays often occur because outpatient follow-up arrangements are unclear or incomplete. In addition, morning clinic and didactics were the main reasons fellows could not complete inpatient rounds before noon.<br /><br />The authors conclude that fellows generally understand the importance of early discharge, but there is room for improvement in both education and workflow. They suggest creating a formal process for consultant discharge approval and outpatient follow-up coordination. They also recommend reconsidering morning clinic and academic scheduling, since these obligations may interfere with early rounding and timely discharge.

Asset Subtitle

Charlotte H. Chaiklin

Meta Tag

Author List Chad Flowers, Charlotte H. Chaiklin, Efren Manjarrez, Ian Magruder, Liana Woodley-Pearson, Maya Khandker, Tiffani Houston

Category Research

Concept Early Discharge

Concept Hospital Flow

Concept Consultant Discharge Recommendation

Concept Emergency Department Overcrowding

Concept Length of Stay

Distinguished Non-Finalist

Presenter Organization University of Miami/Jackson Memorial Hospital

Presenting Author Charlotte H. Chaiklin

Track Consultative Medicine

Keywords

early discharge

internal medicine fellows

academic medical center

hospital discharge

emergency department overcrowding

length of stay

patient flow

survey

consultant approval

outpatient follow-up

Early Discharge

Hospital Flow

Consultant Discharge Recommendation

Emergency Department Overcrowding

Length of Stay