*Purpose: Hospital bed capacity and patient throughput are persistent challenges for medical centers. One established strategy for increasing patient throughput and decompressing Emergency Departments is via discharge by noon (DBN) initiatives. However, hospitals are expected to both improve DBN without compromising readmission rates, length of stay (LOS) or patient experience. Additionally, services with complex patients and discharge planning are often considered incapable of success with such hospital metrics. In this study, we demonstrate how a transplant surgery service achieved this goal.

*Methods: In February 2019, we implemented the “Power Through” initiative in the Transplant Surgery Service. Tools employed to improve DBN included weekday disposition meeting, weekday afternoon multidisciplinary patient discussion, all level education, leadership support and team buy-in. We compared the rate of DBN, readmission rate, LOS and patient satisfaction data pre-intervention (January 2018-January 2019) to post-intervention (February 2019-February 2020).

*Results: We found that during pre-intervention phase 8.2% cases (42 of 513 cases) and post-intervention 35.8% cases (237 of 662 cases) achieved DB. This was a significant improvement (p-value < 0.001) with the post-intervention relative risk of discharge-by-noon being 4.37 times that of pre-intervention. The statistical process control charts showed a clear attributable variation associated with the intervention (fig b). Further, there was a significant (p-value < 0.001) shift in the density plot (fig a) showing early discharges. Our readmission rate decreased marginally from 22.2% to 20.5% with neither chi-square test nor statistical process control charts showing any significant difference. The overall mean LOS decreased from 7.54 to 6.98 while the LOS in the DBN cases increased from 4.98 to 5.20 days, both of which were insignificant (fig c and d). Lastly, the key domains of the HCAHPS survey pertaining to discharge information and communication showed regular month to month variation and no changes were attributed to the intervention (fig e).

*Conclusions: With definitive, multi-level, multi-disciplinary and consistent efforts, we achieved significant improvement in DBN is our surgical service with complex patients who have complicated discharge needs. This improvement was sustained over a year and without harm or compromise to patient care. This achievement improved hospital throughput and cost savings.

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