Targeted Interventions to Improve Discharge Times in an Australian Cardiology Department: a Before-and-After Study

Background Late discharges in cardiology inpatient units contribute to patient flow inefficiencies, emergency department overcrowding, and reduced hospital capacity. We define late discharges as those that occur after 12:00pm. Methods We conducted a quality improvement initiative using the Plan-Do-Check-Act framework over the course of one year. We evaluated a baseline mean discharge time in patients over the course of one month and identified causes of delays. Then, through iterative qualitative analysis we generated and implemented new departmental policies aimed at improving discharge times. We then re-assessed discharge outcomes at one, and six months post intervention. Results Following intervention, we saw a reduction in median discharge time of 1h 27m (95% CI 0:11-2:14, p<0.01) after one month compared to baseline. This was sustained at after six months with a 1h 20m reduction (95% CI 0:23-2:10, p<0.01), with no significant difference between the one and six month periods. Participants were also more likely to have a timely discharge before 12:00 at one (RR=3.03, 95% CI 1.84 – 4.99. p<0.01) and six (RR=2.39, 95% CI 1.43 – 4.01. p<0.01) months, compared to baseline. Conclusion Targeted interventions significantly improved discharge efficiency in a cardiology inpatient unit, enhancing patient flow and operational performance. This framework can inform similar initiatives in other settings.