Jeff Zoucha1,2, Madelyne Hull3, Angela Keniston2,3, Katarzyna Mastalerz2,4, Roswell Quinn5, Arnold Tsai6, Jacob Berman7, Jennifer Lyden1,2,7, Sarah A Stella1,2, Marisa Echaniz1,2, Nicholas Scaletta1,2, Karina Handoyo2,4, Estebes Hernandez5, Inderpreet Saini5, Aneesah Smith6, Andrew Young6, Meghaan Walsh7, Mark Zaros7, Richard K Albert8, Marisha Burden9,8. 1. Division of Hospital Medicine, Denver Health, Denver, Colorado, USA. 2. Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA. 3. Department of Medicine, Denver Health, Denver, Colorado, USA. 4. Presbyterian St-Luke's Medical Center, Denver, Colorado, USA. 5. University of California Los Angeles-Ronald Reagan, Los Angeles, California, USA. 6. Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA. 7. University of Washington, Harborview Medical Center, Seattle, Washington, USA. 8. Department of Medicine, University of Colorado, Denver, Colorado, USA. 9. Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA. marisha.burden@ucdenver.edu.
Abstract
BACKGROUND: Understanding the issues delaying hospital discharges may inform efforts to improve hospital throughput. OBJECTIVE: This study was conducted to identify and determine the frequency of barriers contributing to delays in placing discharge orders. DESIGN: This was a prospective, cross-sectional study. Physicians were surveyed at approximately 8:00 AM, 12:00 PM, and 3:00 PM and were asked to identify patients that were "definite" or "possible" discharges and to describe the specific barriers to writing discharge orders. SETTING: This study was conducted at five hospitals in the United States. PARTICIPANTS: The study participants were attending and housestaff physicians on general medicine services. PRIMARY OUTCOMES AND MEASURES: Specific barriers to writing discharge orders were the primary outcomes; the secondary outcomes included discharge order time for high versus low team census, teaching versus nonteaching services, and rounding style. RESULTS: Among 1,584 patient evaluations, the most common delays for patients identified as "definite" discharges (n = 949) were related to caring for other patients on the team or waiting to staff patients with attendings. The most common barriers for patients identified as "possible" discharges (n = 1,237) were awaiting patient improvement and for ancillary services to complete care. Discharge orders were written a median of 43-58 minutes earlier for patients on teams with a smaller versus larger census, on nonteaching versus teaching services, and when rounding on patients likely to be discharged first (all P < .003). CONCLUSIONS: Discharge orders for patients ready for discharge are most commonly delayed because physicians are caring for other patients. Discharges of patients awaiting care completion are most commonly delayed because of imbalances between availability and demand for ancillary services. Team census, rounding style, and teaching teams affect discharge times.
BACKGROUND: Understanding the issues delaying hospital discharges may inform efforts to improve hospital throughput. OBJECTIVE: This study was conducted to identify and determine the frequency of barriers contributing to delays in placing discharge orders. DESIGN: This was a prospective, cross-sectional study. Physicians were surveyed at approximately 8:00 AM, 12:00 PM, and 3:00 PM and were asked to identify patients that were "definite" or "possible" discharges and to describe the specific barriers to writing discharge orders. SETTING: This study was conducted at five hospitals in the United States. PARTICIPANTS: The study participants were attending and housestaff physicians on general medicine services. PRIMARY OUTCOMES AND MEASURES: Specific barriers to writing discharge orders were the primary outcomes; the secondary outcomes included discharge order time for high versus low team census, teaching versus nonteaching services, and rounding style. RESULTS: Among 1,584 patient evaluations, the most common delays for patients identified as "definite" discharges (n = 949) were related to caring for other patients on the team or waiting to staff patients with attendings. The most common barriers for patients identified as "possible" discharges (n = 1,237) were awaiting patient improvement and for ancillary services to complete care. Discharge orders were written a median of 43-58 minutes earlier for patients on teams with a smaller versus larger census, on nonteaching versus teaching services, and when rounding on patients likely to be discharged first (all P < .003). CONCLUSIONS: Discharge orders for patients ready for discharge are most commonly delayed because physicians are caring for other patients. Discharges of patients awaiting care completion are most commonly delayed because of imbalances between availability and demand for ancillary services. Team census, rounding style, and teaching teams affect discharge times.
Authors: John T Ratelle; Michelle Herberts; Donna Miller; Ashok Kumbamu; Donna Lawson; Eric Polley; Thomas J Beckman Journal: J Patient Exp Date: 2021-04-08