How much do operational processes affect hospital inpatient discharge rates?
ABSTRACT The objective of this study is to determine the effect of day of the week, holiday, team admission and rotation schedules, individual attending physicians and their length of coverage on daily team discharge rates.
We conducted a retrospective analysis of the General Internal Medicine (GIM) inpatient service at our institution for years 2005 and 2006, which included 5088 patients under GIM care.
Weekend discharge rate was more than 50% lower compared with reference rates whereas Friday rates were 24% higher. Holiday Monday discharge rates were 65% lower than regular Mondays, with an increase in pre-holiday discharge rates. Teams that were on-call or that were on call the next day had 15% higher discharge rates compared with reference whereas teams that were post-call had 20% lower rates. Individual attending physicians and length of attending coverage contributed small variations in discharge rates. Resident scheduling was not a significant predictor of discharge rates.
Day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Introducing greater holiday and weekend capacity as well as reorganizing internal processes such as admitting and attending schedules may potentially optimize discharge rates.
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ABSTRACT: House staff work-hour regulations have required residency programs to reengineer inpatient services. However, few data describe how house staff workload on a patient's day of admission or on subsequent hospital days influences patient outcomes. Retrospective cohort analysis of 5742 adults admitted to an academic general medical service between July 1, 1998, and June 30, 2001. After multivariate risk adjustment for patient severity and other structural factors, we found that 2 different measures of house staff workload significantly affected patient outcomes. House staff workload increases on the day of admission, defined as each additional team admission on a patient's admission day, increased length of stay (difference, 3.09%; 95% confidence interval [CI], 2.22%-3.96%), total costs (difference, 2.31%; 95% CI, 1.29%-3.33%), and risk of inpatient mortality (odds ratio, 1.09; 95% CI, 1.02-1.15). Patients had an even higher mortality risk when more than 9 patients were admitted to their team on their admission day. In contrast, house staff workload increases during the patient's entire stay, defined as every additional patient added to the team average census, reduced length of stay (difference, -5.30%; 95% CI, -4.54% to -6.07%) and total costs (difference, -5.11%; 95% CI, -4.20% to -6.00%). Reductions in length of stay and costs were most striking when the team average census exceeded 15 patients. Our findings suggest that higher house staff workload on admitting days-when fewer backup resources are available-increases resource use and may increase inpatient mortality. Conversely, a higher average team census was associated with reduced resource use, perhaps reflecting service-level adaptations to workload. Future studies should confirm these findings in larger trials.Archives of Internal Medicine 02/2007; 167(1):47-52. · 11.46 Impact Factor
- Emergency Medicine Journal 04/2003; 20(2):149-55. · 1.65 Impact Factor
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ABSTRACT: Improving team structure and heightening communication will help provide cost-effective and high-quality patient care for general surgery patients. This study surveys teamwork initiatives and their effects on specific variables related to patient care. The study population comprised all patients admitted to the hospital's general surgery teams during 5 years 3 months. Tertiary care hospital. A complete restructuring of the patient care team for general surgery patients admitted to the hospital. The intervention occurred midway through the study period. Mean length of stay for general surgery patients as a marker of team efficiency and a standardized patient satisfaction survey. The mean length of stay after initiation of the restructured care team was significantly shorter than before initiation. The significance was present despite a consistent patient acuity measure and was associated with a high patient satisfaction level. Restructuring the patient care team yielded a decreased mean length of stay while maintaining a high level of patient satisfaction. This analysis helps validate a hospital-wide initiative to maintain a high level of patient care while increasing patient volume.Archives of Surgery 12/2004; 139(11):1194-8. · 4.10 Impact Factor