Standardized criteria show sustained reduction in hospital stay

A new approach to hospital discharges at UCLA reduced the time patients spent waiting to leave the hospital by nearly 50% for four common diagnoses and improved length of hospital stay by 2.5 days, according to a new pilot study at UCLA Health. Researchers say the standardized system could also serve as a case study for U.S. hospitals facing insufficient bed capacity and slow patient throughput.

In the study published in the journal BMJ Open Quality, the UCLA Health Ronald Reagan Medical Center implemented an 18-month discharge improvement test for four common neurological and medical conditions: transient ischemic stroke, seizures, demyelinating diseases and syncope, or fainting.

Using input from stakeholders involved from patient admission to discharge, the pilot study created a standardized consensus criteria for discharge for the four medical conditions to determine if discharge times and inpatient length of stay at the hospital would be reduced.

The results were significant: median time from discharge orders to actual discharge dropped 49% from 171 to 88 minutes, while overall median hospital stays decreased by 2.5 days. The reduction persisted six months after implementation, with median discharge times stable at 92 minutes and median hospital stay declining even further to 30 hours.

"We replaced arbitrary, physician-specific discharge decisions with consensus-based criteria developed by neurology and medicine specialists," said the study's lead author Dr. Melissa Reider-Demer, a UCLA Health DNP. "This allowed our entire care team including nurses, pharmacists, case managers and transport staff to predict and coordinate discharges more efficiently."

The study involved 318 patient visits in UCLA Health's emergency, observation and inpatient neurology units. Prior to implementing the new standardized discharge criteria, researchers took a baseline measurement of the time it took for patients to be discharged, and length of stay over a period of six months. The new criteria were then implemented for the next six months and a follow-up period of six months to determine its effectiveness.

After the change, more than 80% of patients were discharged within two hours of orders being placed. These improvements persisted six months after the formal study period ended, and hospital readmission rates in the emergency room remained low at approximately 1.5%.

The transition from arbitrary time-based discharge to consensus-based discharge has been recommended by the nonprofit health care organization, the Institute for Healthcare Improvement.

"Previously, different doctors had different thresholds for when patients were ready to go home," Reider-Demer explained.

Establishing clear, consensus criteria mitigates delays due to variable provider preferences and empowers discharging providers."

Dr. Melissa Reider-Demer, University of California - Los Angeles Health Sciences

While consensus-based discharge criteria and discharge pathways are tailored to specific hospitals and institutions, Reider-Demer said the framework at UCLA can serve as a template for other hospitals for other heath conditions and departments.