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We identified all patient discharges from two general pediatric services between April 2014 and October 2015
Each service included an attending physician for one week at a time and a resident team (senior resident and two interns) each month
We obtained the order time for each discharge from the electronic medical record and calculated the mean order time for each attending and resident team
We used fixed-effect regression estimators, controlling for unit, service, and weekend vs. weekday, to determine the proportion of the variance in order time attributable to physicians
Background
Variation in Physician Discharge Order Time at An Academic Children’s Hospital
Hospital discharge is a complicated process, with time of discharge order influenced by a number of factors
Further study is needed to determine which factors have the greatest influence on physician discharge order time in order to help focus quality improvement efforts in this area
Our findings do not preclude the possibility of future identification of physician-controlled factors that would have an impact on discharge order time
The mean physician discharge order time at an academic children's hospital varied modestly between attending physicians
Differences in mean order times were greater between resident teams
The amount of overall variation in discharge order time attributable to physicians in this system was very small
Authors: Stephens JR,1 Steiner MJ,1 Skinner AC,1 Galin S,2 Troxler H,2 Bradford KK1
Institutions: (1) Department of Pediatrics, University of North Carolina, (2) North Carolina Children’s Hospital
We identified 2,858 discharge orders
There were 38 different resident/intern teams
Teams were supervised by 21 different attending physicians
Mean physician discharge order time was 1:12 pm during the study
Weekly mean discharge order times varied substantially (Figure 1)
Individual attending mean discharge order times ranged between 12:30 and 2:12 pm (SD, 29 minutes)
Resident/intern team mean discharge order times ranged between 11:45 am and 3 pm (SD, 42 minutes)
In fixed-effect regression analysis, 1.9% of variance in order time could be attributed to the attending physician and 5.3% to the resident/intern team
Results
Methods
Conclusions
Implications
Hospital discharges early in the day help facilitate patient throughput and improve capacity
A key step in the discharge process is physician entry of the discharge order
The degree of variation in physician discharge order time has not been explored
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1 11 21 31 41 51 61 71 81
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Week of Study
Weekly Mean Physician Discharge Order Times For Two General Pediatric Ward Teams
Service A
Service B
Mean
Figure 1
