E-DIP: Early Discharge Project. A Model for Throughput and Early Discharge for 1-Day Admissions

Short stay admissions that are outside of observation unit models hold challenges for throughput and decreasing length of stay (LOS). In our institution at Mount Sinai Hospital in New York City, United States, we noticed a lack of communication about potential next-day discharges from the day and night admission teams to the inpatient teams. Our hospitalist division started the Early Discharge Initiation Project (E-DIP), a system of flagging and communicating potential discharges to improve this problem. We used a multidisciplinary approach with PDSA cycles, engaging members of all teams involved in this process, including the nocturnists. We utilized a paper list, an EHR notification order, and email communication to relay potential next-day discharges. We created an awareness and educational campaign to reinforce the process and its importance. We then used a text paging system to remind the inpatient teams for early discharge. After the initiation of E-DIP, the average number of 1-day admissions per day increased from 0.9 to 1.6 (78% increase). Percentage of discharge orders before 11AM increased from 28% to 42%. Mean discharge time improved to 28 minutes earlier. E-DIP was successful in increasing 1-day admissions and mean discharge times.