Discharge in the a.m.: A randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay

Abstract

Background: To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences. Objective: We aimed to test the effects of hospitalist physicians prioritizing discharging patients first compared to usual rounding style.Design, Setting and Participants: Prospective, multi-center randomized controlled trial. Three large academic hospitals. Participants were Hospital Medicine attending-level physicians and patients the physicians cared for during the study who were at least 18 years of age, admitted to a Medicine service, and assigned by standard practice to a hospitalist team.Intervention: Physicians were randomized to: (1) prioritizing discharging patients first as care allowed or (2) usual practice. Main Outcome and Measures: Main outcome measure was discharge order time. Secondary outcomes were actual discharge time, length of stay (LOS), and order times for procedures, consults, and imaging. Results: From February 9, 2021, to July 31, 2021, 4437 patients were discharged by 59 physicians randomized to prioritize discharging patients first or round per usual practice. In primary adjusted analyses (intention-to-treat), findings showed no significant difference for discharge order time (13:03 ± 2 h:31 min vs. 13:11 ± 2 h:33 min, p =.11) or discharge time (15:22 ± 2 h:50 min vs. 15:21 ± 2 h:50 min, p =.45), for physicians randomized to prioritize discharging patients first compared to physicians using usual rounding style, respectively, and there was no significant change in LOS or on order times of other physician orders. Conclusions: Prioritizing discharging patients first did not result in significantly earlier discharges or reduced LOS.