JHQ 320: Enhanced Discharge Bundles to Reduce Length of Stay-JHQ 320: Article

JHQ 320: Article

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A multidisciplinary task force at a 616-bed academic hospital implemented an “enhanced discharge bundle” to reduce inpatient length of stay (LOS) amid worsening capacity constraints after the pandemic and rising emergency department (ED) and inpatient volumes. Hospital Medicine, the hospital’s largest inpatient service (~6,500 adult discharges/year), served as the pilot site.<br /><br />From January–June 2023, the team rolled out multiple coordinated interventions: (1) an optimized discharge process led by primary teams, including prioritizing early discharge order placement and revamping multidisciplinary rounds (MDRs) using standardized checklists, twice-daily huddles, and attendance tracking; (2) a case management/social work (CM/SW) redesign, adding staffing to support expanded hours and seven-day discharge planning, shifting utilization management tasks to a dedicated utilization review team, reassigning administrative tasks, balancing caseloads, defining standard work and escalation pathways, and improving payer authorization escalation; (3) twice-weekly reviews of high-risk and long-stay patients; and (4) development of real-time and strategy dashboards within the electronic health record to track discharge-related process measures and LOS outcomes.<br /><br />The evaluation compared post-intervention performance (July–December 2023) with a seasonally matched pre-intervention period (July–December 2022), excluding the implementation phase. Patient demographics and clinical characteristics were similar across periods and were adjusted for in regression models.<br /><br />Mean inpatient LOS decreased from 6.5 to 5.8 days. After adjustment, inpatient LOS was reduced by 0.56 days (95% CI −1.0 to −0.09; p=.019). Total hospital LOS also fell by 0.49 days (p=.04). Importantly, 7- and 30-day all-cause readmissions and ED returns did not increase. In-hospital mortality was slightly lower (adjusted OR 0.60; p=.044), though absolute rates were low.<br /><br />Financially, the LOS reduction was estimated to save 3,647 bed-days annually, with a conservative return on investment of about 5:1 relative to hiring 15 new CM/SW-related positions. Limitations included incomplete capture of readmissions to outside hospitals and residual confounding from transferred/ICU-level cases. The hospital plans to scale the approach and further address discharge delays and ED throughput.

Keywords

enhanced discharge bundle

inpatient length of stay reduction

academic hospital capacity constraints

hospital medicine service pilot

multidisciplinary rounds standardized checklist

case management social work redesign

seven-day discharge planning

utilization review team and payer authorization escalation

electronic health record real-time dashboards

readmissions and emergency department return rates