Abstract 105: A 360 Degree Perspective on the Timing of Patient Discharge: A Multidisciplinary Survey of Patients, Physicians, and Nurses on Discharge Practices Within a Cardiovascular Service Line at a Tertiary Academic Institution

Abstract

Background: Early hospital discharge for patients has been linked to improved post-discharge outcomes. Health systems continue to struggle with early discharges and past interventions have centered around provider perspectives of the discharge process, with no identifiable studies focusing on patient perspectives. We sought to examine the discharge process from a comprehensive perspective, obtaining simultaneous patient and healthcare provider beliefs to improve our institution’s discharge process. Methods: Our study was approved by the Institutional Review Board at the University of Pennsylvania and all participants provided informed consent. Physicians and nurses who took part in discharges from our inpatient cardiology services participated in an electronic survey regarding discharge processes over a six-month period. Patients being discharged from these services also completed anonymous surveys at the time of discharge from the hospital. Results: The survey was completed by 476 patients, 47 nurses, and 44 physicians. Approximately 54% of physicians and 43% of nurses reported that the ideal time of discharge is between 8:00 AM and 12:00 PM. A vast majority (85%) of patients reported that discharges before 2:00 PM are best, with 60% of patients reporting that discharges should ideally occur before 12:00 PM. Nearly half (46%) of patients, 64% of physicians, and 75% of nurses reported that the discharges they participated in occurred after 2:00 PM, which was consistent with the mean discharge times reported by institutional data taken during the survey period. Less than half (40%) of patients also reported that they were informed of their discharge before 12:00 PM on their day of discharge. The majority of healthcare providers reported that they do not believe early discharges would reduce the rate of 30-day readmissions (physicians 87%, nurses 88%) or lead to safer discharges (physicians 78%, nurses 69%). More than one-third (36%) of patients reported that a delay in coordination of transitional care (e.g. medication delivery, transportation issues, and inadequate communication with primary team) contributed to a later discharge time. Conclusion: Our data reveal that both patients and providers believe that the optimal time for discharge is prior to 12:00 PM, despite the fact that most discharges occur after 2:00 PM. Patients cite delays in coordination of transitional care as the most common reason for delayed discharge times, and were typically informed of their formal discharge after noon on the day of discharge. Although most healthcare providers do not believe that early discharge improves outcomes, additional studies are needed to investigate outcomes associated with early discharge time.