How much do operational processes affect hospital inpatient discharge rates?

Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.
Journal of Public Health (Impact Factor: 2.04). 06/2009; 31(4):546-53. DOI: 10.1093/pubmed/fdp044
Source: PubMed


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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    • "For example, inefficient processes within GIM may increase length of stay that effectively decreases the discharge rate and subsequent rate at which ED boarders are transferred to the ward (Figure 12). Therefore, an in-depth analysis of non-clinical operational factors that regulate the downstream process of discharge on the GIM service for a 2-year period was conducted (Wong et al, 2009). The results indicated significant variation in daily discharge rates caused by inefficient hospital processes , most notably limited weekend and holiday capacity and team admission schedules. "
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