Father walks child down hallway of the hospitalDoes a Discharge Before Noon affect length of hospital stay? Perhaps.

A common strategy used by hospitals to reduce overcrowding of inpatient units may not produce consistent results, a new study suggests. Discharges Before Noon, or DCBNs, are thought to mitigate overcrowding and improve patient outcomes by allowing for earlier emergency department admissions; however, studies of the relationship between DCBNs and length of stay have had mixed results. At the same time, early discharge rates remain a high priority for many hospitals across the country.

To better understand this relationship, Hailey J. James, MHA, and George M. Holmes, PhD, of the Department of Health Policy and Management at the Gillings School of Global Public Health partnered with Michael J. Steiner, MD, MPH, and John R. Stephens, MD, of the Department of Pediatrics at the School of Medicine.

Together, they conducted a retrospective study of inpatient admissions at NC Children’s Hospital from May 2014 to April 2017. Length of stay of patients who were discharged from the hospital before noon where compared to the length of stay of those patients discharged after noon. Patients in the study included ages 21 or younger who spent at least one night in the hospital. According to their analysis, DCBNs were associated with decreased lengths of stay in medical admissions, but not surgical ones.

“We think this study illuminates the importance of continuous evaluation of operational practices with the goal of maximizing desired outcomes,” said Ms. James and Dr. Stephens in a joint statement. “Discharge before noon is an attractive measure of efficiency for hospitals because it is easy to measure and has face validity. However, the evidence is not clear that early discharges are associated with shorter hospital stays for all patients.”

The use of DCBNs to measure discharge efficiency may not be appropriate for all services and ultimately, the authors conclude, more studies are needed. Their findings are set to be published in an upcoming article, “The Association of Discharge Before Noon and Length of Stay in Hospitalized Pediatric Patients,” available in the January 2019 issue of the Journal of Hospital Medicine.