Background: Benefits of early hospital discharge include decreased length of stay, improved patient satisfaction, and more efficient resource utilization. Patients admitted to inpatient cardiology units are excellent candidates for targeting early discharge, particularly after uncomplicated procedures.
Aim: We planned to increase the rate of pre-11:00 AM discharges from 7% to 14% within 12 weeks on the inpatient cardiology unit of a single university hospital.
Methods: The Gold Star pilot program was initiated in the cardiology unit at Emory University Hospital. Potential next-day discharges were designated Gold Star status if the patient had no procedural complications, complex discharge needs, pending consults, or incomplete tests. Providers notified nurses and social workers by placing a Gold Star communication order in the patient’s EMR. Day and night shift nurses completed a checklist for patient education and transportation planning. In the morning, the provider completed a discharge order by 9:00 AM and the patient was discharged by 11:00 AM. We measured the proportion of patients with a discharge order in EMR by 9 AM, and who were discharged by 11 AM, during a 4-week “baseline” period (n=146 patients); a 3-week period of implementing Gold Star discharges from the interventional cardiology service (n=133); and 9 more weeks after “full implementation” i.e. expanding the program to the general cardiology, heart failure, and electrophysiology services (n=352).
Results: The proportion of discharge orders placed before 9 AM was 8.9% (13 of 146) at baseline versus 12.2% (43 of 352) after full implementation (p=0.35 by Fisher’s exact test). The proportion of discharges occurring before 11 AM rose from 6.8% (10 of 146) at baseline to 14.5% (51 of 352) after full implementation (p=0.0166, Figure). Mean (median) length of stay was 4.1 (3) days at baseline and 4.0 (3) days after full implementation (p=0.88 by Student’s t-test).
Conclusions: The Gold Star program facilitated pre-11 AM discharges from an inpatient cardiology unit. Barriers to early discharge include wait time for diagnostic studies, failure to identify Gold Star eligible patients, and delays in transportation. We continue to address these barriers and plan to replicate our program at other hospitals within our health system.