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Patient Safety and Quality Improvement

Improving Discharge Timing Through Dedicated Suction Machine Delivery

Monday, October 2, 2023
3:57 PM - 4:03 PM East Coast USA Time
Location: 202A
Disclosure(s):
David S. S. Haynes, MD, MMHC: No relevant relationships to disclose.
Eben L. Rosenthal, MD: No relevant relationships to disclose.
Sarah L. Rohde, MD, MMHC: No relevant relationships to disclose.
Marc L. Bennett, MD, MMHC: No relevant relationships to disclose.
Introduction: Inpatient capacity constraints have driven health systems to implement earlier discharges to accommodate surgical cases. Otolaryngology – head and neck surgery (OHNS) patients often have unique challenges for discharge to home beyond conventional post-operative cares.

Methods: We conducted a quality improvement study to improve inpatient discharge to home before 11:00 AM (dcby11) by in an OHNS department at a tertiary care center. A target of 19.1% dcby11 was predetermined by the center. Multivariable regression analyses used to determine key factors for dcby11 over a 6-month period, after which a series of interventions were developed and implemented. Discharges were then monitored for an additional 6 months and changes analyzed with interrupted time series regression.

Results: Nine-hundred forty-one consecutive OHNS inpatient discharges were studied over the course of a 1.5-year period. During the observational period (6 months), multivariable analyses of 362 consecutive discharges identified delays in securing durable medical equipment (DME) for home discharge as the most significant modifiable factor to improving discharge timing (β = 1.40; p = 0.02). Patient demographics (including distance to the hospital), clinical histories, admitting service teams/attendings, and discharge unit did not significantly impact discharge time. Over the subsequent 6 months, a partnership was developed with a dedicated DME vendor improved timely delivery of suction machines to patients prior to discharge. This intervention improved the dcby11 from 15.2% (n = 643 discharges) to 22.1% in the subsequent 6 months (n = 298; p = 0.02).

Conclusions: Dedicated relationships with DME vendors (especially for suction machines) may help expedite OHNS patient discharges.