Discharge before noon: is the sun half up or half down?

Objectives: To analyze the impact of discharge before noon (DBN) on length of stay (LOS) and readmission of adult inpatients.

Study Design: Retrospective analysis of 78,826 patients from a single tertiary care center between January 1, 2016, and December 31, 2018.

Methods: The patient population was divided between patients discharged before and after noon. Outcomes were analyzed with univariate and multivariate analyses.

Results: DBN was independently associated with higher likelihood of LOS above the median (odds ratio [OR], 1.26; 95% CI, 1.18-1.35; P < .001) among medical patients. This association was not seen among surgical patients, in whom DBN was associated with a shorter LOS (OR, 0.78; 95% CI, 0.71-0.86; P < .001). Factors associated with higher LOS in both medical and surgical groups included higher case mix index, Medicaid payer, weekday discharges, and discharge to skilled nursing or rehabilitation facilities. For the variable of readmission, DBN in surgical patients was associated with a lower readmission rate (OR, 0.81; 95% CI, 0.69-0.95; P = .008).

Conclusions: The finding that DBN was associated with higher LOS among medical patients suggests that some patients may have been able to be safely discharged the evening prior. In patients with surgical diagnoses, DBN was associated with a lower LOS and a lower risk of readmission. Patients with later discharges were more likely to be sent to a rehabilitation center or skilled nursing facility and were more frequently discharged during a weekday. Identification of these factors may help health systems transition patients safely and efficiently out of the hospital.