Hospital executives are rightfully focused on the length of inpatient episodes of care, as well as the relative efficiency of the discharge process itself. The Prospective Payment System (i.e., DRG’s) is associated with a fixed inpatient payment for various diagnostic groups, and excessively long stays days can result in substantial financial losses. Additionally, diminished inpatient bed capacity places a premium on freeing up occupied beds as efficiently as possible.

Hospitalist physicians are viewed as key influencers of discharge metrics, via their role as primary admitters and co-managers of specialist patient admissions. Any practicing Hospitalist can attest to the importance Medical Centers place on inpatient discharges.

As Consultants/Advisors to Medical Centers and Hospitalist Programs, we encounter significant frustration when it comes to this subject. Frustration among Hospital executives and frustration among Hospitalists. From our vantage point, the source of frustration lies not with the objective of managing the episode of care and related processes efficiently. Rather, the source of frustration relates to the processes employed to affect change.

More specifically, we have observed the following to be in need of improvement:

• Few Hospitalists are properly educated on the importance of an efficient inpatient length-of-stay
• Most Hospitalists are not aware how they compare to their peers regarding discharge efficiency–either within the Group or Regionally/Nationally
• “Discharge Before Noon” and related metrics do not impact desired outcomes, as they fail to encompass the multitude of variables impacting actual time of discharge
• Most Episode of Care and Discharge Metrics are established without grassroots input from the Hospitalists

In response, Salient MD offers several positive solutions to address these issues:

• Presenting a Hospitalist Primer as it relates to the importance of an efficient inpatient episode of care
• Developing a Discharge Efficiency Index – facilitating ongoing internal Group comparisons
• Engaging Hospitalists and key stakeholders in identifying opportunities to favorable impact efficiency in the inpatient episode of care and “day of discharge” process

We tend to live at 10,000 feet, but change happens with the feet of those responsible for enacting change.