Home Discharges On the clock

On the clock

December 2013

Published in the December 2013 issue of Today’s Hospitalist

How often do you look at the clock during a shift?

For many hospitalists, the answer to that question may change in the not-so-distant future. And not surprisingly, some of you may not be too happy with the reasons why.

With Medicare’s new “two-midnight rule” dictating who can be considered an inpatient, watching the clock has become more important than ever. And with the details of the new rule still something of a mystery, physicians everywhere are paying close attention to when they first “and last “see patients in the confines of the hospital.

While the Medicare rule affects nearly everyone in the inpatient setting, hospitalists are grappling with another time-based initiative: early discharges. Our story takes a look at hospitals that are trying to discharge patients by the late morning. The goal is to free up beds to unclog emergency rooms.

Some hospitalists support these initiatives, claiming that making the discharge process more efficient will benefit patients and hospitals alike. But others worry that patient flow is way too complex ” and important “to be run according to a clock.

Critics warn that setting an “arbitrary” measure like time may not only give hospitalists perverse incentives on when to discharge patients, but may actually lead to problems with care. One physician recalls an early discharge that went wrong when the patient was rushed out the door a little too quickly.

These are valid concerns, but the reality is that as health care reform marches on, there’s going to be more “not less “of a push to improve efficiency. That means that the clock will likely play an even bigger role in the way you practice.

edoyleEdward Doyle
Editor & Publisher