Journal of Public Health Advance Access published online on May 22, 2009
Journal of Public Health, doi:10.1093/pubmed/fdp044
How much do operational processes affect hospital inpatient discharge rates?
Hannah Wong, PhD Candidate1,2,3
Robert C. Wu, Assistant Professor4,5
George Tomlinson, Associate Professor4,6
Michael Caesar, Director of Information Management3,4
Howard Abrams, Associate Professor4,5,7
Michael W. Carter, Professor1,2
Dante Morra, Assistant Professor4,5
1 Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
2 Centre for Research in Health Care Engineering, University of Toronto, Toronto, ON, Canada
3 Shared Information Management Services, University Health Network, Toronto, ON, Canada
4 Centre for Innovation in Complex Care, Toronto General Hospital, University Health Network, Toronto, ON, Canada
5 Department of Medicine, University of Toronto, Toronto, ON, Canada
6 Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada
7 Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
Address correspondence to Dante Morra, Email: dante.morra{at}uhn.on.ca
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Abstract |
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Background The objective of this study is to determine the effect of day of the week, holiday, team admission and rotation schedules, individual attending physicians and their length of coverage on daily team discharge rates.
Methods We conducted a retrospective analysis of the General Internal Medicine (GIM) inpatient service at our institution for years 2005 and 2006, which included 5088 patients under GIM care.
Results Weekend discharge rate was more than 50% lower compared with reference rates whereas Friday rates were 24% higher. Holiday Monday discharge rates were 65% lower than regular Mondays, with an increase in pre-holiday discharge rates. Teams that were on-call or that were on call the next day had 15% higher discharge rates compared with reference whereas teams that were post-call had 20% lower rates. Individual attending physicians and length of attending coverage contributed small variations in discharge rates. Resident scheduling was not a significant predictor of discharge rates.
Conclusions Day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Introducing greater holiday and weekend capacity as well as reorganizing internal processes such as admitting and attending schedules may potentially optimize discharge rates.
Keywords: day of the week, discharge rate, holiday, operational efficiency, scheduling