355 - Drivers of Morning Hospital Discharges in US Children's Hospitals.

Publication Number: 4348.355

Anum Dadwani, University of Texas Southwestern Medical School, Plano, TX, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Vineeta Mittal, UT Southwestern Medical Center, Dallas, TX, United States

Background: Efficient and safe discharges are crucial for hospital flow and capacity. However, not enough is known about hospital discharge timing and factors that drive morning discharges.

Objective: The aims for this project were to: i) identify discharge patterns across children's hospitals, and ii) identify patient-level and hospital-level factors associated with morning discharges.

Design/Methods: A retrospective analyses of 2024 discharges were conducted using the Pediatric Health Information System. Inclusion criteria were patients aged 0-19 years, with inpatient or observation status discharged to home. Birth hospitalizations, discharge from ICU, discharge to inpatient psychiatry or rehabilitation/long-term stay facility or in-hospital deaths were excluded. Exposures included demographics, travel distance to facility, Childhood Opportunity Index (COI), number of complex chronic conditions (CCC) and medical technology use, season and day of the week. Discharge times were defined as morning (before 11 am), routine(11a-6.59p) and late (7p-11.59p). The percent of morning discharges were compared across hospitals. Clustered on hospital, a generalized estimated equation model was developed to identify factors associated with morning discharges.

Results: 79,6901 hospitalizations from 47 hospitals met the inclusion criteria; 80% were medical encounters. Of these, 11% of medical and 18% of surgical discharges occurred before 11 am with the majority occurring between 11a-7p. 8.4% of medical discharges occur between 7p-midnight. (Table 1) Surgical encounter, age 1-4 years, males, private insurance, living >50 mile from facility, any CCC, having 1-2 medical technologies and weekend discharge were all associated with morning discharges. Season and average daily census of a hospital were not associated with morning discharge. (Table-2). Hospital-level variation in morning discharges exist for both medical and surgical encounters (Fig.1).

Conclusion(s): Our study highlights that 10.9% of medical and 18.1% surgical discharges occur before 11 am with patient-level factors that impact them. Hospital-level variation in early discharges exists. While most discharges occur between 11m-7pm, 8.4% of medical discharges occur after 7 pm. Focusing on both early and late discharge metrics might be crucial to optimize hospital flow.

Socio demographics and Clinical Characteristics
Discharge Times: Sociodemographics and clinical characteritics

Factors Associated with Morning Discharges
Factors that drive morning discharges

Hospital-level variation in early discharge time.
Median morning discharge time for medical discharges was 9.9% and 15.9% for surgical encounters. Variation was seen among 47 childrens hospitals.