Discharge before noon: An achievable hospital goal
Discharge before noon: An achievable hospital goal
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DOI：
10.1002/jhm.2154
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发表时间：
2014-04-01
影响因子：
2.6
通讯作者：
Hochman, Katherine
中科院分区：
文献类型：
--
作者：
Wertheimer, Benjamin;Jacobs, Ramon E. A.;Hochman, Katherine
下午晚些时候出院被认为是造成入院瓶颈、过度拥挤和住院时间延长的原因。2012年1月，2个医疗单位的中午前出院（DBN）百分比为7%，低于30%的组织目标。为了可持续地实现30%的DBN率，并评估该干预对预期（O/E）LOS和30天再入院率的影响。学术医疗中心。病人所有住院病人出院的单位。干预所有工作人员帮助创建一个清单的日常责任在DBN启动事件。我们发起了下午的跨学科轮，以确定第二天的DBN，并创建了一个网站，以加强沟通。我们提供了每日DBN百分比反馈、成功奖励和实时病例回顾机会。测量每月DBN百分比、O/E LOS和30天再入院率。结果DBN百分比从8个月基线期的11%增加到13个月干预期的平均38%（P = 0.0002）。平均出院时间提前了1小时31分钟。O/E LOS从1.06下降到0.96（P = 0.0001），30天再入院率从14.3%下降到13.1%（P = 0.1902）。未来的工作将允许更好地了解这种干预对患者结局和医院指标的全面影响。医院医学杂志2014;9：210-214。(c)2014年医院医学学会
BACKGROUNDLate 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%.OBJECTIVETo sustainably achieve a DBN rate of 30% and to evaluate the effect of this intervention on observed-to-expected (O/E) LOS and 30-day readmission rate.DESIGNPre-/post-intervention retrospective analysis.SETTINGTwo acute care inpatient medical units in an urban, academic medical center.PATIENTSAll inpatients discharged from the units.INTERVENTIONAll staff helped create a checklist of daily responsibilities at a DBN kickoff event. We initiated afternoon interdisciplinary rounds to identify next-day DBNs and created a website for enhanced communication. We provided daily feedback on the DBN percentage, rewards for success, and real-time opportunities for case review.MEASUREMENTSCalendar month DBN percentage, O/E LOS, and 30-day readmission rate.RESULTSThe DBN percentage increased from 11% in the 8-month baseline period to an average of 38% over the 13-month intervention (P = 0.0002). The average discharge time moved 1 hour and 31 minutes earlier in the day. The O/E LOS declined from 1.06 to 0.96 (P = 0.0001), and the 30-day readmission rate declined from 14.3% to 13.1% (P = 0.1902).CONCLUSIONSOur study demonstrates that increased DBN is an achievable and sustainable goal for hospitals. Future work will allow for better understanding of the full effects of such an intervention on patient outcomes and hospital metrics. Journal of Hospital Medicine 2014;9:210-214. (c) 2014 Society of Hospital Medicine