Resident Physician Oklahoma State University Medical Center Tulsa, Oklahoma
Background and Hypothesis: Hospital discharges can be a complex orchestration of multidisciplinary teams with significant logistic bottle-necks. Late discharge times from a hospital are not just inconvenient to hospitals, but may negatively impact the course of care and result in financial implications to patients. This study initiated a quality improvement campaign at Oklahoma State University Medical Center (OSUMC) to achieve more efficient discharge times. We hypothesized that a resident-led educational initiative to resident hospitalist teams would result in earlier discharge times.
Methods: The first step of the study was to determine a potential baseline discharge order time and determine if an educational initiative could improve that baseline. The research team identified strategies that included ways to optimize timely discharge at time of admission, during hospital stay, and at time of discharge. A tip sheet summarizing the strategies was distributed through email to all Internal Medicine and Family Medicine residents, posted in resident charting areas, and reinforced by assigned residents on Internal Medicine and Family Medicine hospitalist teams during the intervention. Discharge time data was collected from a 10-week period at OSUMC, extending over the five weeks prior to the educational initiative and the 5 weeks after the deployment of the initiative. The sample for this study consisted of 974 discharge orders prior to the intervention and 1,021 discharge orders after the intervention. All deceased patients and those who left against medical advice were excluded from the study.
Results: An earlier discharge time was observed after the implementation of the intervention. The post intervention group had an average discharge order time of 1248 compared to an average of 1303 found prior to the intervention, indicating an improvement of 15 minutes (99% CI [0.0366-0.6234], p-value < 0.001). The study was limited by a short observation interval. Further research should examine the lasting nature of the intervention and application into other hospital teams, such as nursing and specialty services.
Conclusion: The study demonstrated that resident-led educational interventions can result in measurable improvement in discharge order times. Improving whole-patient care through resident-to-resident education is essential to advancing the practice of osteopathic medicine into the future.
Acknowledgement of Research Study Sponsors and IRB: This study did not have any funding from sponsors or grants. IRB was reviewed and determined to be exempt.
