Identifying Core Functions and Forms of "Discharge by Noon" Interventions

Many hospitals have implemented Discharge by Noon (DBN) programs to improve hospital throughput but have had mixed results. Use a complex health intervention framework to define core functions and forms of DBN interventions. Qualitative study combined with scoping review. Two hospitals in Michigan,...

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Published in:Journal of general internal medicine : JGIM 2025-01
Main Authors: Patel, Jigisha, Shrestha, Sachita, Marr, Ruby, Caseley, Paul, Mack, Megan, Singh, Vijay, Paje, David, Chang, Robert, Taylor, Stephanie Parks
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container_title Journal of general internal medicine : JGIM
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Shrestha, Sachita
Marr, Ruby
Caseley, Paul
Mack, Megan
Singh, Vijay
Paje, David
Chang, Robert
Taylor, Stephanie Parks
description Many hospitals have implemented Discharge by Noon (DBN) programs to improve hospital throughput but have had mixed results. Use a complex health intervention framework to define core functions and forms of DBN interventions. Qualitative study combined with scoping review. Two hospitals in Michigan, USA. Multidisciplinary stakeholders (n = 22) involved in the development and implementation of a DBN program. We conducted (1) stakeholder surveys and (2) a scoping review of the DBN literature. We integrated quantitative and qualitative data to develop a DBN functions and forms matrix. Qualitative thematic analysis of the stakeholder survey identified six core functions addressing five motivating needs for a DBN program, and the scoping review identified one additional core function addressing one additional motivating need. We identified 17 eligible studies for the scoping review, of which 15 (88%) found an improvement in DBN associated with the intervention and two (12%) did not. Compared with ineffective interventions, a greater proportion of effective ones enabled multi-disciplinary participation (76% vs 0%), provided a structured platform for communication (65% vs 0%), and enabled pre-identification of patients (59% vs 0%). Cross-case analysis revealed that programs that included either enablement of multi-disciplinary participation or structured platform for communication covered 100% of effective interventions and no ineffective ones. Successful DBN programs include specific core functions. Our findings can guide system recommendations about optimal DBN intervention structures to maximize effectiveness and resource stewardship.
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title Identifying Core Functions and Forms of "Discharge by Noon" Interventions
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