November 10, 2023

The Disconnect Between Discharge and Demand

By Lane Wise, Director of Client Outcomes, ABOUT 




One health system went from having very limited available capacity to having enough beds to meet patient demand, by making one simple change. No, they did not hire more nurses or add acute care beds. In fact, they did not make a structural investment at all. They looked at their admission and discharge data and implemented a single change to improve patient movement through their system. 


In acute care, efficient patient discharge planning is crucial to ensuring the seamless flow of patients through the system. The following delves into the disconnect between discharge and demand planning, and the best practices to address the issue. By optimizing discharge times, health systems can improve patient care, enhance bed availability, and minimize the burden of waitlisting, ED holding, and lost patients. 


The Problem


Capacity issues have been plaguing hospitals, resulting in excessive waitlisting, ED holding, and lost patients. Health systems are facing significant challenges optimizing patient throughput and minimizing length of stay, particularly in the post-acute discharge process. Patients ready for discharge but unable to transition is one of the leading causes of health system capacity issues. The disconnect between discharge and demand leads to inefficient use of resources and hinders patient care. Solving this challenge has become a strategic priority, spurred by the pressing need to serve communities and patients effectively. 


In acute care, every moment counts. Unfortunately, arbitrary daily discharge times without considering actual demand patterns, can inadvertently lead to significant capacity issues affecting the entire healthcare ecosystem. Inefficient discharge processes only aggravate this issue. 


Getting the right patients into the hospital is becoming more difficult, and there needs to be a place for them to receive care when they arrive. To address this challenge, health systems are seeking solutions to enhance care management, to increase capacity, and improve patient outcomes. If health systems do not address this issue as a strategic initiative, they risk falling behind, especially considering many leading health systems have been tackling this problem pre-pandemic. 


The Best Practice Solution


A key to creating capacity lies in optimizing the timing of patient discharges. A crucial step is aligning discharge times with the actual demand for beds. This can be a challenge as patient demand information is often siloed, originating from various sources including the emergency department, admissions, and transfer centers. To tackle this issue effectively, health systems need to implement best practices to connect post-acute discharge with patient demand planning. 


1. Identify Optimal Discharge Times 

The first step is to identify the optimal times of day for patient discharges. This involves a detailed analysis of typical demand patterns and aligning discharge times accordingly. Leveraging analytics and historical patient flow data, health systems can pinpoint windows of high demand when beds are needed most. By analyzing data and comparing the demand curve with actual discharge times, health systems can identify gaps, and make informed decisions on where capacity can be created.  


2. Stakeholder Collaboration 

The success of any change in the healthcare system hinges on collaboration among all stakeholders. It is imperative to ensure that everyone involved, from bedside provider to ancillary services, is aware of the optimal discharge times. Commitment to removing roadblocks is vital. This may involve streamlining processes, ensuring adequate staffing, and fostering clear communication channels. 


Similar to managing disjointed patient demand, the patient discharge process can be unwieldy. Care managers face hurdles placing patients with various post-acute care facilities and services meeting specific patient criteria. A care orchestration tool can enable these best practices, making demand and discharge information visible in one platform and facilitating automated stakeholder collaboration for increased performance. 


Rather than setting fixed discharge hours, organizations can aim for a staggered approach informed by demand data, such as discharging 25% of patients by 9 am and another 25% by 11 am. This balanced approach encourages all stakeholders to work together to streamline the discharge process, ensuring patients are moved to the most appropriate level of care efficiently. 


The Effectiveness


Implementing these best practices results in tangible improvements in the health system. Measuring these optimized discharge practices is vital to gauge their impact on patient care and health system efficiency. First and foremost, they are better equipped to serve their communities by making more beds available for patients in need. This timely access to care is crucial for acute care patients. 


1. Increased Bed Availability 

One of the primary benefits is a measurable increase in available beds during times of high demand. This means that patients in need can access care promptly, reducing the risk of complications, and improving overall outcomes. By optimizing discharge times, healthcare facilities can efficiently turn over beds, ensuring they are available when needed most. 


2. Reduced Waitlisting, ED Boarding, and Lost Patients

The direct outcome of this optimization is a decrease in the use of waitlisting, ED boarding, and lost transfers. Patients no longer have to endure extended waits in emergency departments or be stuck in care settings mismatched with their needs. This leads to all patients receiving the care they require at the right location, which is the primary goal of any health system. The burden on transportation teams is also alleviated during peak discharge hours, leading to more efficient patient transport, and care delivery. 




Efficiency and patient-centered care go hand in hand. Connecting patient demand with the post-acute discharge process is a crucial step toward achieving these goals. Identifying the best times for discharge, fostering collaboration among stakeholders, and measuring the effectiveness of these changes maximizes available resource capacity. 


Ultimately, implementing and measuring these strategies underscore their value in improving patient access to care, maximizing bed availability, and minimizing waitlisting challenges and lost patients. In doing so, they contribute to an enhanced patient and provider experience.