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The Distributions of Weekday Discharge Times at Acute Care Hospitals in the State of Florida were Static from 2010 to 2018

  • Systems-Level Quality Improvement
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Abstract

When hospital capacity is near census, either due to limits on the number of physical or staffed beds, delays in patients’ discharge can result in domino effects of congestion for the emergency department, the intensive care units, the postanesthesia care unit, and the operating room. Hospital administrators often promote increasing the percentage of patients discharged before noon as mitigation. However, benchmark data from multiple hospitals are lacking. We studied the time of weekday inpatient discharges from all 202 acute care hospitals in the state of Florida between 2010 and 2018 using publicly available data. Statewide, the average length of stay (4.63 days) did not change, but hospital discharges increased 6.1%. There was no change over years in the percentage of patients discharged before 12 noon (13.0% ± 0.28% standard error [SE]) or before 3 PM (42.2% ± 0.25% SE). For every year, the median hour of patient discharge was 3 PM. Only 9 of the 202 hospitals (4.5%) reliably achieved a morning weekday discharge rate ≥ 20.0%. Only 19 hospitals (9.4%) in the state reliably achieved a ≥ 50.0% weekday discharge rate before 3 PM. Hospital administrators seeking to achieve earlier patient discharges can use our provided data as realistic benchmarks to guide efforts. Alternatively, administrators could plan based on a model that beds will not be reliably available for new patients until late in the afternoon and apply other well-developed operational strategies to address bottlenecks affecting the internal transfer of patients within the hospital.

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Notes

  1. PubMed search on August 26, 2019: ((“patient discharge”[MeSH Terms] AND (“bed capacity”[TIAB] OR “hospital capacity”[TIAB] OR “hospital discharge time”[TIAB])) OR ((“bed occupancy”[MeSH Terms] OR “hospital bed capacity”[MeSH Terms]) AND “crowding”[MeSH Terms])) OR (discharge before home) returned 329 articles. Examination of the abstracts identified 16 studies relevant to efforts to improve the timeliness of hospital discharge for inpatients, which were then read.

  2. There were 210 unique acute care hospitals in 2006 and 219 in 2018, a net increase of 4.3%. The number of licensed beds increased by 3.1%, from 57,144 to 58,939. During this interval, the resident population in Florida increased by 17.7%, from 18.09 to 21.30 million [26].

  3. This value matches with the South Atlantic portion of the 2016 National Inpatient Sample mean length of stay for short-term acute care hospitals of 4.7 days (30). This subset includes data from Delaware, Maryland, the District of Columbia, Virginia, West Virginia, North and South Carolina, Georgia, and Florida. The nearly identical vales for mean length of stay demonstrates congruent validity of our analyzed dataset.

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Richard H. Epstein helped design the study, obtain the data, analyze the data, and write the manuscript. Franklin Dexter helped design the study, analyze the data, and write the manuscript. Christian Diez helped write the manuscript.

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Correspondence to Franklin Dexter.

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The University of Miami Institutional Review Board determined on August 12, 2018, that this research does not meet the regulatory definition of human subjects research.

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Epstein, R.H., Dexter, F. & Diez, C. The Distributions of Weekday Discharge Times at Acute Care Hospitals in the State of Florida were Static from 2010 to 2018. J Med Syst 44, 47 (2020). https://doi.org/10.1007/s10916-019-1496-x

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