Reduction of Discharge Delay Cuts Inpatient Neurology and Medicine Length of Stay
Colin McCrimmon1, Christopher Saigal2, Scott Marks3, Linda Czypinski4, Melissa Reider-Demer5
1UCLA, 2Urology, 3Analytics, UCLA Health, 4UCLA Medical Center, 5Neurology, UCLA Medical Group
Objective:
To determine overall effects of a process to discharge at least 80% of neurology and medicine inpatients within two hours of medical readiness.
Background:
Inefficient discharge processes hinder hospital throughput and limit access to care. To mitigate discharge inefficiency, we developed a standardized discharge pathway outlining stakeholder responsibilities and incorporating consensus-based discharge criteria for key conditions. This effort aimed to improve discharge predictability, and reducing discharge delays and length of stay (LOS).
Design/Methods:
A multidisciplinary team at an academic medical institution implemented a standardized discharge pathway from November 1, 2022, to September 30, 2025. Stakeholder-specific checklists supported adherence to respective roles. Neurology and Internal Medicine hospitalist teams jointly defined Medically Ready for Discharge (MRD) consensus criteria for selected diagnoses classified by U.S. News & World Report.
Upon meeting MRD criteria, providers entered discharge orders and notified care team members via secure messaging that triggered nurse-initiated discharge within two hours. Data were tracked through interdisciplinary rounds and analyzed using statistical process control charts (SPCC, X-charts, S-charts, and P-charts).
Results:
During the study period, 87% of 686 patients were discharged within two hours of MRD. Discharge time was reduced by 87 minutes from 180 to 93 minutes. LOS was reduced by 3.4 days from 5.2 to 1.8 days. Case Mix Index (CMI) increased from 1.78 to 2.09. Excess bed days were reduced by 2 days. Provider feedback confirmed that the process added no additional time burden to workflow. Inpatient and 30-day emergency room admissions remained stable throughout the study period, indicating absence of adverse effects.
Conclusions:
In neurology and internal medicine services, reduction of discharge delays by a standardized discharge pathway with MRD criteria can significantly improve LOS, CMI, and bed availability without compromising safety or workflow.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.