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      Discharge timeliness and its impact on hospital crowding and emergency department flow performance.

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          Abstract

          The objective of this research is to identify optimal inpatient discharge time targets to help hospitals reduce crowding, improve patient flow through the ED and balance staff workload.

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          The relationship between inpatient discharge timing and emergency department boarding.

          Peter Adams, Gilles Reinhardt, R Khare … (2012)
          Patient crowding and boarding in Emergency Departments (EDs) impair the quality of care as well as patient safety and satisfaction. Improved timing of inpatient discharges could positively affect ED boarding, and this hypothesis can be tested with computer modeling. Modeling enables analysis of the impact of inpatient discharge timing on ED boarding. Three policies were tested: a sensitivity analysis on shifting the timing of current discharge practices earlier; discharging 75% of inpatients by 12:00 noon; and discharging all inpatients between 8:00 a.m. and 4:00 p.m. A cross-sectional computer modeling analysis was conducted of inpatient admissions and discharges on weekdays in September 2007. A model of patient flow streams into and out of inpatient beds with an output of ED admitted patient boarding hours was created to analyze the three policies. A mean of 38.8 ED patients, 22.7 surgical patients, and 19.5 intensive care unit transfers were admitted to inpatient beds, and 81.1 inpatients were discharged daily on September 2007 weekdays: 70.5%, 85.6%, 82.8%, and 88.0%, respectively, occurred between noon and midnight. In the model base case, total daily admitted patient boarding hours were 77.0 per day; the sensitivity analysis showed that shifting the peak inpatient discharge time 4h earlier eliminated ED boarding, and discharging 75% of inpatients by noon and discharging all inpatients between 8:00 a.m. and 4:00 p.m. both decreased boarding hours to 3.0. Timing of inpatient discharges had an impact on the need to board admitted patients. This model demonstrates the potential to reduce or eliminate ED boarding by improving inpatient discharge timing in anticipation of the daily surge in ED demand for inpatient beds. Copyright © 2012 Elsevier Inc. All rights reserved.
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            Unravelling relationships: Hospital occupancy levels, discharge timing and emergency department access block.

            Sankalp Khanna, Justin Boyle, Norm Good … (2012)
            To investigate the effect of hospital occupancy levels on inpatient and ED patient flow parameters, and to simulate the impact of shifting discharge timing on occupancy levels. Retrospective analysis of hospital inpatient data and ED data from 23 reporting public hospitals in Queensland, Australia, across 30 months. Relationships between outcome measures were explored through the aggregation of the historic data into 21 912 hourly intervals. Main outcome measures included admission and discharge rates, occupancy levels, length of stay for admitted and emergency patients, and the occurrence of access block. The impact of shifting discharge timing on occupancy levels was quantified using observed and simulated data. The study identified three stages of system performance decline, or choke points, as hospital occupancy increased. These choke points were found to be dependent on hospital size, and reflect a system change from 'business-as-usual' to 'crisis'. Effecting early discharge of patients was also found to significantly (P < 0.001) impact overcrowding levels and improve patient flow. Modern hospital systems have the ability to operate efficiently above an often-prescribed 85% occupancy level, with optimal levels varying across hospitals of different size. Operating over these optimal levels leads to performance deterioration defined around occupancy choke points. Understanding these choke points and designing strategies around alleviating these flow bottlenecks would improve capacity management, reduce access block and improve patient outcomes. Effecting early discharge also helps alleviate overcrowding and related stress on the system. © 2012 CSIRO. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
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              Discharge before noon: an achievable hospital goal.

              Martha Bailey, Sandy Holstein, Steven Chatfield … (2014)
              Late afternoon hospital discharges are thought to contribute to admission bottlenecks, overcrowding, and increased length of stay (LOS). In January 2012, the discharge before noon (DBN) percentage on 2 medical units was 7%, below the organizational goal of 30%.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Emerg Med Australas
                Title: Emergency medicine Australasia : EMA
                Publisher: Wiley-Blackwell
                ISSN (Electronic): 1742-6723
                ISSN (Print): 1742-6723
                Publication date (Electronic): Apr 2016
                Volume: 28
                Issue: 2
                Affiliations
                [1 ] CSIRO Australian e-Health Research Centre, Brisbane, Queensland, Australia.
                [2 ] CSIRO Digital Productivity Flagship, Melbourne, Victoria, Australia.
                [3 ] Mental Health Directorate, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
                Article
                DOI: 10.1111/1742-6723.12543
                PubMed ID: 26845068
                SO-VID: 9f8c4804-396b-470a-b2e1-819261ea99d3
                History

                Keywords: hospital administration,crowding,discharge planning,emergency medicine,bed occupancy
                Data availability:
                Keywords: hospital administration, crowding, discharge planning, emergency medicine, bed occupancy

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