Inpatient Discharge-By-Noon: Are Fewer Better than All?

Introduction: To address boarding in hospital emergency departments, discharge-by-noon could free up inpatient beds earlier in the day. However, discharging all patients by noon can heavily burden inpatient units and may not be feasible. In this study, we determine the number of discharges after which the benefits of an additional discharge-by-noon diminish. Methods: We conducted a simulation analysis to quantify how occupancy rate, mean daily number of discharges, and peak discharge time impact upstream boarding time in an inpatient neurology unit at Maine Medical Center. Using a day-of-discharge simulation model with one year of retrospective data, we assessed configurations approximating various inpatient units to increase the number of patients discharged by noon from 1 to all. Measured outcomes included the (1) average upstream boarding time across all patients and (2) average time of day for discharge completion. Results: Units with a higher occupancy rate, later peak time of day for discharge, or more discharges may benefit more from discharge-by-noon initiatives. For any unit configuration studied, approximately 75% of the maximum expected reduction in boarding time (when all-by-noon is implemented) can be achieved by discharging half of the average daily discharges by noon. Discussion: Studies have aimed to achieve all discharges before noon. Our study suggests that although discharging patients by noon reduces upstream boarding time, discharging all by noon does not eliminate upstream boarding. Hospitals may have better outcomes by implementing strategies based on the characteristics of specific units. Conclusions: Although setting a discharge target can help an inpatient unit better achieve earlier discharges and reduce upstream patient boarding, discharge-by-noon does not need to be used in its original form of “all” by noon.