Key result
Multidisciplinary QI initiative increases discharge delay documentation to ~24%.
Why the study?
Documenting medically ready for discharge dates and discharge delays in the electronic medical record was initiated to better allocate resources, streamline patient flow, and identify trends among vulnerable populations.
Does a multidisciplinary quality improvement initiative increase the documentation of discharge delays in hospitalized patients on a Medicine unit?
Does a multidisciplinary quality improvement initiative increase the documentation of discharge delays in hospitalized patients on a Medicine unit?
A multidisciplinary quality improvement initiative successfully increased the documentation of discharge delays, revealing that patients with higher social vulnerability are disproportionately affected by delays related to consults, home coordination, and transportation.
May support EMR tracking of discharge delays to improve flow; leaves open whether documentation reduces length of stay.
In July 2021, our institution launched a program to begin documenting the medically ready for discharge date (MRDD) and the discharge delays (DDs) in the electronic medical record (EMR) to better allocate resources to streamline patient flow. The MRDD is the date at which a patient is deemed clinically stable for discharge by their medical team. DDs describe the reasons why a patient remains in the hospital beyond the MRDD. Our aim was to increase entry of DDs from 1.7% to ≥10% in hospitalized patients on a 26-bed Medicine unit between November 2023 and October 2025. The DD information would enable us to identify trends among vulnerable patient populations. We implemented Plan-Do-Study-Act cycles utilizing in-person and email communication by interdisciplinary teams as well as incorporating specific columns into the residents' EMR. We additionally stratified DD types based on the patient social vulnerability index. Since November 2023, the percentage of documented DDs for patients discharged beyond the MRDD was sustained above the target of 10% and peaked at 24% in October 2025. The most common themes of DDs were Placement, Disposition, Consult, and Home Coordination. We also found patients with higher social vulnerability index were disproportionately affected by DDs, including Consult, Home Coordination, and Transportation.
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Bana et al. (2026) studied Hospitalized patients. Multidisciplinary quality improvement initiative (Plan-Do-Study-Act cycles) vs. Baseline documentation practices was evaluated on Percentage of documented discharge delays (DDs) for patients discharged beyond the medically ready for discharge date. A multidisciplinary quality improvement initiative utilizing Plan-Do-Study-Act cycles increased the documentation of discharge delays from a baseline of 1.7% to a peak of 24%.
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