A Nurse-driven, Multidisciplinary Intervention to Improve the Morning Discharge Rate on an Inpatient Medical Oncology Unit

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Publication Date

4-9-2026

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Presentation: 33:58

Abstract

Emergency department (ED) boarding, a more than four-hour lag between admission order placement and transfer to an inpatient bed, is associated with adverse events including increased length of stay, poor adherence to standard of care and patient mortality. Morning discharges can alleviate ED boarding by improving hospital throughput. While discharge-before-noon interventions have been successful on general medicine wards, data regarding their feasibility on oncology units is sparse. Here, PROPEL, a nurse-driven multi-thematic intervention is applied to a 28-bed medical oncology unit at an urban, tertiary, academic medical center to target a sustained 20% pre-11:00 a.m. discharge rate over 22 months. Three plan-do-study-act (PDSA) cycles were utilized. Multidisciplinary care coordination rounds, discharge activity checklists, overnight initiation of electrolyte and blood product infusions, prioritized morning work rounds, bedside discharge medication delivery and a dedicated discharge navigation nurse contributed to an increase in pre-11:00 a.m. discharges. The overall mean discharge rate at baseline was 8.5%, improving to 15.6%, 28.4% and 22.4% for the first, second and third PDSA cycles, respectively (p< 0.001). The weekly mean discharge times were significantly earlier first the first (2:46 p.m. (95% CI: 2:27 p.m. to 3:05 p.m.)) and second (2:22 p.m. (95% CI: 2:01 p.m. to 2:50 p.m.)) PDSA cycles compared with the baseline (3:25 p.m. (95% CI: 3:03 p.m. to 3:42 p.m.), p=0.0003). Top barriers to morning discharge included medical decision-making, finishing chemotherapy and coordinating durable medical equipment delivery or transfer to skilled nursing facility. No change in patient satisfaction was observed. Morning discharges are feasible and sustainable on a medical oncology unit.

Language

English

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