Discharge in the a.m.: A randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.
Journal
Journal of hospital medicine
ISSN: 1553-5606
Titre abrégé: J Hosp Med
Pays: United States
ID NLM: 101271025
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
revised:
18
01
2023
received:
09
08
2022
accepted:
26
01
2023
medline:
4
4
2023
pubmed:
17
2
2023
entrez:
16
2
2023
Statut:
ppublish
Résumé
To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences. We aimed to test the effects of hospitalist physicians prioritizing discharging patients first compared to usual rounding style. Prospective, multi-center randomized controlled trial. Three large academic hospitals. Participants were Hospital Medicine attending-level physicians and patients the physicians cared for during the study who were at least 18 years of age, admitted to a Medicine service, and assigned by standard practice to a hospitalist team. Physicians were randomized to: (1) prioritizing discharging patients first as care allowed or (2) usual practice. Main outcome measure was discharge order time. Secondary outcomes were actual discharge time, length of stay (LOS), and order times for procedures, consults, and imaging. From February 9, 2021, to July 31, 2021, 4437 patients were discharged by 59 physicians randomized to prioritize discharging patients first or round per usual practice. In primary adjusted analyses (intention-to-treat), findings showed no significant difference for discharge order time (13:03 ± 2 h:31 min vs. 13:11 ± 2 h:33 min, p = .11) or discharge time (15:22 ± 2 h:50 min vs. 15:21 ± 2 h:50 min, p = .45), for physicians randomized to prioritize discharging patients first compared to physicians using usual rounding style, respectively, and there was no significant change in LOS or on order times of other physician orders. Prioritizing discharging patients first did not result in significantly earlier discharges or reduced LOS.
Sections du résumé
BACKGROUND
To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences.
OBJECTIVE
We aimed to test the effects of hospitalist physicians prioritizing discharging patients first compared to usual rounding style.
DESIGN, SETTING AND PARTICIPANTS
Prospective, multi-center randomized controlled trial. Three large academic hospitals. Participants were Hospital Medicine attending-level physicians and patients the physicians cared for during the study who were at least 18 years of age, admitted to a Medicine service, and assigned by standard practice to a hospitalist team.
INTERVENTION
Physicians were randomized to: (1) prioritizing discharging patients first as care allowed or (2) usual practice.
MAIN OUTCOME AND MEASURES
Main outcome measure was discharge order time. Secondary outcomes were actual discharge time, length of stay (LOS), and order times for procedures, consults, and imaging.
RESULTS
From February 9, 2021, to July 31, 2021, 4437 patients were discharged by 59 physicians randomized to prioritize discharging patients first or round per usual practice. In primary adjusted analyses (intention-to-treat), findings showed no significant difference for discharge order time (13:03 ± 2 h:31 min vs. 13:11 ± 2 h:33 min, p = .11) or discharge time (15:22 ± 2 h:50 min vs. 15:21 ± 2 h:50 min, p = .45), for physicians randomized to prioritize discharging patients first compared to physicians using usual rounding style, respectively, and there was no significant change in LOS or on order times of other physician orders.
CONCLUSIONS
Prioritizing discharging patients first did not result in significantly earlier discharges or reduced LOS.
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, U.S. Gov't, P.H.S.
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
302-315Subventions
Organisme : AHRQ HHS
ID : R03 HS027231
Pays : United States
Organisme : AHRQ HHS
ID : 1R03HS027231-01A1
Pays : United States
Informations de copyright
© 2023 The Authors. Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.
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