Increasing Discharges Prior to 11:00 <scp>am</scp> in Patients with Burn Injuries

This study describes a quality improvement project to increase the number of discharges prior to 11am in a high-volume Burn Center. A limited supply of staffed inpatient beds creates capacity constraints and can adversely affect patient flow.1 Discharging patients earlier may help promote throughput, improve length of stay (LOS) as well as patient satisfaction, and decrease costs.2 Burn injured patients face unique barriers to discharge prior to 11am compared to other inpatient groups. We used the Four Disciplines of Execution (4DX) quality improvement framework, which focuses on identifying key drivers to achieve a specific, time-delimited goal. Our primary target was increasing discharges prior to 11am to 30% over the span of 6 months. Four additional months were measured to assess for process drift. Interventions included (a) designation of "priority discharge" patients, (b) discharge order entry prior to 0930, and (c) decreasing time between discharge order entry and actual patient discharge. Baseline data was gathered from July 1st until Nov 30th 2022 and compared to the intervention period December 1st, 2022 through Sept 30th, 2023. Discharges prior to 11am increased from 10.0% to 27.1% over the course of the project. Median discharge time improved by 72 minutes. Discharge order entry time improved by 83 minutes. Potential special-cause variation was identified in December 2022. Despite not meeting our initial target, discharges prior to 11am were significantly increased after implementing a multidisciplinary approach between nursing, providers, case management and social work.