Annie Massart, MD, Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Rajkomar A et al. J Hosp Med 2016 Dec.

A retrospective cohort study suggests discharge before noon is associated with longer hospital lengths of stay.

Some hospitals try to boost patient “throughput” and open up beds by encouraging clinicians to discharge patients before noon. But are clinicians achieving this goal by retaining patients overnight and discharging them early the next day?

Researchers evaluated nearly 30,000 medical and surgical discharges during 3 years at an urban teaching hospital and compared patients who were discharged before noon (17% of discharges) to those discharged later in the day. Multivariate and propensity-score analysis (adjusted for case mix, service type, weekend discharge, discharge disposition, age, race, payer class, and urgency of admission) showed a significantly longer median length of stay (LOS) for patients discharged before noon than for patients discharged later in the day (3.7 vs. 3.4 days; odds ratio, 1.04). In prespecified subgroup analyses, longer median LOS in before-noon discharges remained significant in medical patients (vs. surgical patients; OR, 1.12) and in patients admitted emergently (vs. nonemergently; OR 1.14).

CITATION(S):

Rajkomar A et al. The association between discharge before noon and length of stay in medical and surgical patients. J Hosp Med 2016 Dec; 11:859. 

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