Discharge in the AM

NCT05370638 | Completed

• 1 other identifier: 19-1607
• Study Type: interventional
• Target: 61
• Locations: 1 country
• Sites: 1

Brief Summary

As hospitals around the country continue to work to manage a high patient census, provider prioritization of discharges is one low cost mechanism to help improve patient throughput and patient length of stay. The investigators conducted a prospective randomized study to understand if this commonly utilized approach to expedite care results in earlier discharges and lower hospital lengths of stay while also understanding the impact on other patient care (such as test and consult order times on other patients that the physician is caring for).

Conditions

Hospitalism; Flow or Discharge

Keywords

hospitalist; patient flow; early discharge; discharge before noon; inpatient

Outcome Measures

Primary Outcomes (1)

• Physician discharge order time

  Physician discharge order time entered into the electronic health record

  From the midnight of the day the patient was discharged until time the patient had a discharge order placed, assessed up to 6 months from the start of the study.

Secondary Outcomes (3)

• Patient discharge time

  From the midnight of the day the patient was discharged until the time the patient was discharged from the hospital, assessed up to 6 months from the start of the study.

• Patient length of stay

  From the time that the patient was admitted to hospital until time the patient had a discharge order placed, assessed up to 6 months from the start of the study.

• Average time of day of orders for imaging, consults, or procedures were entered by participating physicians into the electronic health record

  From the midnight of the day each day to the time of day each patient had an order placed for imaging, consults, or procedures, assessed up to 6 months from the start of the study.

Study Arms (2)

rounding on discharging patients first

EXPERIMENTAL

Rounding on discharging patients meant that the attending physician and accompanying team (i.e. if they were working with advanced practice providers or learners) would prioritize seeing any patients that were going to discharge that day.

Other: Rounding on discharging patients first

usual practice

NO INTERVENTION

Usual practice was categorized as: seeing discharging patients first, sickest patients, decompensating patients, new patients (i.e. patients admitted to their team overnight), or based on geography.

Interventions

Rounding on discharging patients first OTHER

Rounding on discharging patients meant that the attending physician and accompanying team (i.e. if they were working with advanced practice providers or learners) would prioritize seeing any patients that were going to discharge that day. The attending could break protocol if needed for patient care purposes and this was tracked each day.

rounding on discharging patients first

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Physicians:
• Hospital Medicine attending-level physicians who consented to participate and patients
• Patients:
• At least 18 years of age
• Admitted to a Medicine service and assigned by standard practice to a general medical hospitalist team including a provider who agreed to participate in the study

You may not qualify if:

• Patients assigned, by standard practice, to a general medical hospitalist team and on the team of providers who chose not to participate in the study

Sponsors & Collaborators

• University of Colorado, Denver: lead
• Denver Health and Hospital Authority: collaborator
• Johns Hopkins University: collaborator

Study Sites (1)

University of Colorado

Aurora, Colorado, 80045, United States

Location

Related Publications (1)

• Burden M, Gundareddy VP, Kauffman R, Keach JW, McBeth L, Raffel KE, Rice JD, Washburn C, Kisuule F, Keniston A. Assessing the impact of workload and clinician experience on patient throughput: A multicenter study. J Hosp Med. 2025 May;20(5):471-478. doi: 10.1002/jhm.13555. Epub 2024 Nov 26.

  PMID: 39588662 DERIVED

Study Officials

• Marisha Burden, MD

  University of Colorado School of Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 25, 2022
• First Posted: May 11, 2022
• Study Start: February 9, 2021
• Primary Completion: July 31, 2021
• Study Completion: July 31, 2021
• Last Updated: May 11, 2022

Record last verified: 2022-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)