This document discusses how a hospital improved patient discharge times and satisfaction by having physicians prioritize rounding on likely discharges first in the morning. This resulted in 88 minute earlier discharge orders on average. As a result, patients left the hospital earlier, freeing up 2,336 patient hours. It also improved emergency department wait times by reducing time from bed request to patient arrival on floor by 77 minutes and overall door to admit time by 94 minutes, saving 3,849 patient hours. Patient satisfaction with discharge and emergency department care significantly increased.

1. HOW IMPROVED
DISCHARGE TIMES
CHANGED THE PATIENT
EXPERIENCE
…And everything else
Presented by:
Chaise Camp, MBA, MA, MS, MA
chaisecamp@gmail.com

2. At a 200+ bed hospital located in North Carolina, we
had some challenges we desperately needed to address.
First, patient satisfaction with the discharge process
had seen virtually five consecutive quarterly declines.
33
31
27 28
25
23
20
25
30
35
40
45
50
55
60
Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
Percentile
??

3. Secondly, the average discharge time for Hospitalists’
patients was 3:40 in the afternoon. Patients were
dissatisfied.
But there was hope. Analysis revealed that for every
hour earlier a patient received their discharge order,
that patient left the hospital an average 45 minutes
earlier.
This piqued our curiosity.
What would happen if physicians rounded on
likely discharges first?

4. Hospitalist leadership accepted the challenge. They
would prioritize likely discharges in their morning
rounds. As more Hospitalists joined in, discharge orders
showed dramatic shifts to earlier times.
0%
5%
10%
15%
20%
25%
30%
PercentofPatientsw/DCorders
Time of Discharge Order
Aug May Feb

5. Since February, the mean Hospitalist discharge order
time has fallen by 88 minutes. As predicted, the
average time Hospitalists’ patients leave the hospital is
falling in proportion.
12:42
12:04
12:19
11:43
11:22 11:28
11:14
15:40
15:09 15:15
15:01 14:51 14:53
14:23
11:00
12:12
13:24
14:36
15:48
FEB MAR APR MAY JUN JUL AUG
TimeofDay
Hospitalist DC Order Time (Mean) Hospitalist Patient DC Time (Mean)
77 min. reduction
88 min. reduction

6. Comparing each month’s decline to our February
baseline, we can calculate the number of hours saved
for our waiting inpatients on discharge day. They really
add up!
0
179
147
464 442
483
620
0
100
200
300
400
500
600
700
FEB MAR APR MAY JUN JUL AUG
Hours
Inpatient Hours Saved
2,336 Patient Hours
Saved so Far!

7. Patient Satisfaction with the discharge process rose
suddenly and dramatically as patients began leaving
the hospital earlier on discharge day!
33
31
27 28
25
23
51
49
20
25
30
35
40
45
50
55
60
Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
PercentileRank

8. But the story doesn’t stop there…

9. The earlier discharge times meant inpatient beds
became available to the Emergency Department earlier
in the day. The ED’s time from bed request till the
patient arrived on an inpatient floor fell by 50%.
155 155
111
136
109
72 78
50
100
150
200
250
300
350
400
FEB MAR APR MAY JUN JUL AUG
Minutes
Bed Request to Bed on Floor
77 min. reduction

10. As a result of this improvement and others, the total
door to admit time for ED-admitted patients declined
by an incredible 94 minutes!
155 155
111
136
109
72 78
369 362
335 342
322
275 275
50
100
150
200
250
300
350
400
FEB MAR APR MAY JUN JUL AUG
Minutes
Bed Request to Bed on Floor Door to Admit
77 min. reduction
94 min. reduction

11. The hours saved in the ED each month compared to
February’s baseline is truly staggering! The 3,849 hours
saved so far equates to 160 days worth of waiting for an
inpatient bed.
0
96
382
326
622
1253
1170
369 362
335 342
322
275 275
0
200
400
600
800
1000
1200
1400
50
100
150
200
250
300
350
400
FEB MAR APR MAY JUN JUL AUG
Hours
Minutes
Time Saved for ED Admits Door to Admit
3,849 Patient Hours
Saved so Far!

12. ED-admitted patients’ satisfaction with their ED care
suddenly rose across every indicator.
21
27
68
49
14
19
41 43
34
19
72
59
18
25
62
48
0
10
20
30
40
50
60
70
80
Q1 '15 Q2 '15 Q3 '15 Q4 '15
Percentilerank
Courtesy of ER staff ER wait time before seen doctor
ER:kept inform re:condition/trtmnt Wait time in ER before admitted

13. KEY TAKEAWAYS
• Keep a broad view of what drives the patient experience. It’s
not just about hourly rounding and communication skills.
• Patient Experience departments must take a vested interest
in operations.
• Our Hospitalist team broke with convention by rounding on
likely discharges first (as opposed to sickest first). The
improved throughput, from inpatient to the ED, made the
whole hospital safer. It improved the patient experience and
reduced staff frustrations.