Analyzing Discharge Strategies during Acute Care

Abstract

Background. When to discharge acute care patients is a complex decision that depends on both patient- and system-level factors. Such a decision for one patient affects other patients and operations in a hospital. The key tradeoff that we analyzed was the effect of discharge timing on several emergency department (ED)-related measures and the number of readmissions. Methods. We developed a discrete-event simulation model of patient pathway through an acute care hospital that comprises an ED and several inpatient units. The effects of discharge timing on ED waiting and boarding times, ambulance diversions, leave without treatment, and readmissions were explicitly modeled. We then analyzed the impact of 1 static and 2 proactive discharge strategies on these system outcomes. Results. Our analysis indicated that although the 2 proactive discharge strategies significantly reduced ED waiting and boarding times, and several other measures, compared with the static strategy ( P < 0.01), the number of readmissions increased substantially. Further analysis indicated that these findings are sensitive to changes in patient arrival rate and conditions for ambulance diversion. Conclusions. Determining the appropriate time to discharge patients not only can affect individual patients’ health outcomes, but also can affect various aspects of the hospital. The study improves our understanding of how individual inpatient discharge decisions can be objectively viewed in terms of their impact on other operations, such as ED crowding and readmission, in an acute care hospital.