McCrimmon Colin M, Fensterwald Molly R, Czypinski Linda K, Nuwer Marc R, Abelon Sherrille E, Reider-Demer Melissa
Department of Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Section of Hospital Medicine, Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
BMJ Open Qual. 2025 Aug 22;14(3):e003303. doi: 10.1136/bmjoq-2024-003303.
Poor discharge planning impairs hospital throughput, adds to the financial strain on health systems and diminishes patient and provider satisfaction. We developed consensus-based discharge criteria coupled with a standardised discharge pathway for four presenting diagnoses and tracked their effect on discharge timing and length of stay (LOS).
Medical readiness for discharge criteria for patients diagnosed with transient ischaemic attack, seizure, demyelinating disease or syncope were generated by expert consensus at our institution. A standardised discharge pathway was developed for eligible patients based on discussions with stakeholders and staff. Discharge timing and readmissions were tracked for 6 months pre-intervention and 12 months post-intervention (divided into 6 months of implementation and post-implementation periods). The primary outcome was a discharge time of ≤2 hours for 60% of patients during the implementation period. Secondary outcomes included reduced time to discharge (TTD) and LOS compared with the pre-intervention period.
318 total patient visits were included across the baseline, implementation and post-implementation periods. Median TTD improved from 171 min at baseline to 88 and 92 min, respectively, during the implementation and post-implementation periods. Median LOS similarly decreased from 94 hours to 35 and 30 hours, respectively. All primary and secondary outcomes were achieved during the implementation period and sustained post-implementation. The rate of emergency department visits and hospital readmissions within 30 days remained low (~1.5%) post-intervention. Additionally, most providers reported that the intervention improved clinical workflow.
This standardised discharge framework improved discharge efficiency for patients with four common diagnoses during an 18-month quality improvement study. The framework and its implementation are highly scalable, and similar systems-level approaches should be considered by hospitals to improve throughput.
出院计划不完善会影响医院的工作效率，增加卫生系统的经济负担，并降低患者和医护人员的满意度。我们制定了基于共识的出院标准，并为四种常见诊断制定了标准化的出院流程，同时跟踪其对出院时间和住院时间（LOS）的影响。
我们机构的专家通过共识制定了诊断为短暂性脑缺血发作、癫痫、脱髓鞘疾病或晕厥患者的出院医疗准备标准。基于与利益相关者和工作人员的讨论，为符合条件的患者制定了标准化的出院流程。在干预前6个月和干预后12个月（分为实施期和实施后期6个月）跟踪出院时间和再入院情况。主要结局是在实施期内60%的患者出院时间≤2小时。次要结局包括与干预前期相比，出院时间（TTD）和住院时间缩短。
在基线期、实施期和实施后期共纳入318例患者就诊。TTD中位数从基线时的171分钟分别改善为实施期的88分钟和实施后期的92分钟。住院时间中位数同样从94小时分别降至35小时和30小时。所有主要和次要结局在实施期内均得以实现，并在实施后期得以维持。干预后30天内的急诊科就诊率和再入院率仍然较低（约1.5%）。此外，大多数医护人员报告称该干预改善了临床工作流程。
在一项为期18个月的质量改进研究中，这个标准化的出院框架提高了四种常见诊断患者的出院效率。该框架及其实施具有高度可扩展性，医院应考虑采用类似的系统层面方法来提高工作效率。
