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Effectiveness of Implementing a Predischarge Order to Discharge Patients Before 11 a.m.

Mallipudi, Rajiv M.; Khan, Qamar; Mbolu, George U. Jr; Alquran, Lance; Mehta, Bijal; Allusson, Valerie

doi: 10.1097/JHQ.0000000000000194
Original Article

ABSTRACT Barriers to early discharges include poor communication among the healthcare team and families, pending laboratory test results, delays in discharge orders, medical reconciliation list, and patient transport. The baseline data at our hospital in October 2017 (N = 1,021) showed that 5% of patients were discharged before 11 a.m., with the mean discharge processing time being 145 minutes. The goal of this study was to assess the effectiveness of using an electronic predischarge order to discharge more than 40% of patients before 11 a.m. A predischarge order set was created in the electronic record, which notified the nurses, pharmacists, and case and social workers to complete all tasks related to discharge (medication reconciliation, complete laboratory test results and imaging, and arrange transport with family and nursing homes). The resident teaching service group (N = 381) from November 2017 to September 2018 discharged 22% of their patients before 11 a.m. (baseline: 5%, p value = 3.38638E-22), and the mean total discharge time was 77 minutes (baseline: 145 minutes; p value = 1.12013E-19). Our inability to discharge more than 40% of patients from the resident teaching service group before 11 a.m. was attributed to 3 limitations. We propose three viable recommendations to meet our goal in a future intervention.

For more information on this article, contact Rajiv M. Mallipudi at

All individuals contributed substantially to the conception, formulation, drafting, and revision of the submission and take public responsibility for its content and are listed as authors. All authors participated in the submission's final approval.

There are no conflicts of interests for this research study. This research has not received any public or private funding. This is an original manuscript, and no part of the manuscript has been published before nor is any part of it under consideration for publication at another journal.

© 2019 National Association for Healthcare Quality
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