How much do operational processes affect hospital inpatient discharge rates?

Wong, Hannah J.; Wu, Robert; Tomlinson, George; Caesar, Michael; Abrams, Howard; Carter, Michael; Morra, Dante

doi:10.1093/pubmed/fdp044

Cited by 39 publications

(36 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For hospitals, this translates to standardizing care processes so that weekends run exactly as they do on weekdays, scheduling of imaging procedures and interventions during nights and weekends 17, and consistently discharging patients every day of the week. 18 Such strategies are likely to serve both inpatient and outpatient needs, improve equipment return on investment, shorten queues for service, reduce unnecessary length of stay, and alleviate ED congestion. A recent simulation study found that smoothing inpatient discharges over the course of the week reduced ED length of stay and the number of ED beds occupied by patients waiting for ward transfer by~30%.…”

Section: Innovative Solutionsmentioning

confidence: 99%

Excellent Hospital Care for All: Open and Operating 24/7

Wong

Morra

2011

J GEN INTERN MED

View full text Add to dashboard Cite

Nights and weekends are the times when most people are admitted to the hospital. They are also synonymous with reduced staffing levels and fewer specialized diagnostic, procedural, and treatment options. Indeed, there is increasing evidence suggesting that patient care is compromised during these times. Equally important is the inefficient use of capital investments during nights and weekends, and inappropriate utilization of hospital beds caused by poor weekend discharge flexibility. We believe that these findings should be of concern not just to hospital care providers, but across care settings and to the general public. In this perspective article, we highlight how our current office-hours system of running hospitals threatens the lives of our sickest, most vulnerable patients, describe solutions currently implemented in hospitals that may alleviate this disparity, and discuss challenges to wider scale implementation.KEY WORDS: nights and weekend; hospital care; quality and safety; efficiency.

show abstract

Section: Innovative Solutionsmentioning

confidence: 99%

Excellent Hospital Care for All: Open and Operating 24/7

Wong

Morra

2011

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…Administrators and health care providers are particularly focused on minimizing patient length of stay, ensuring a safe and high quality patient discharge experience and reducing unnecessary readmissions (Connolly et al, 2009;Glasby, Littlechild, & Pryce, 2006;Ontario Ministry of Health Care and Long Term Care, 2010). The concern with length of stay is linked to organizational imperatives concerning patient flow, and the aims to optimize bed availability, minimize emergency department wait times and reduce costs (Office of the Auditor General of Ontario, 2010;Wong et al, 2009). The emphasis on patient safety and quality of care reflects the potential for adverse events to occur during this period of transition and the goal to minimize readmissions (Davis, Devoe, Kansagara, Nicolaidis, and implementation of patient discharge is therefore a complex process involving multiple healthcare workers, driven by a range of, and possibly competing, health, political and economic factors.…”

Section: Introductionmentioning

confidence: 99%

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning

Goldman

Reeves

et al. 2016

Journal of Interprofessional Care

View full text Add to dashboard Cite

Patient discharge is a key concern in hospitals, particularly in acute care given the multifaceted and challenging nature of patients' health care needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and micro-level practices. An ethnographic approach was employed to obtain an in-depth insight into health care providers' perspectives, 2 of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach.

show abstract

“…1 Previous studies demonstrated proportionately fewer discharges occur on the weekend, which may lead to unnecessary hospital days. [2][3][4] There is limited research on how the presence of fewer weekend discharges impacts hospital length of stay (LOS). 5 Not only could the potential inefficiency in weekend discharges add to more health care costs, but it also runs contrary to patient-centered care.…”

mentioning

confidence: 99%