Abstract
When the hospital census is near-capacity, either from insufficient physical beds or nurse staffing, discharge delays can result in postanesthesia care unit (PACU) congestion that backs up the operating rooms. Hospital administrators often promote increasing morning discharges as mitigation. Before the COVID-19 pandemic, most hospitalized Florida patients were discharged after 3 PM, without change from 2010 through 2018. The current study extended the observation period through 2022 to determine if discharge pressure during the COVID-19 pandemic from persistent high census resulted in overall earlier hospital discharges. Results showed the percentages of patients discharged by 12 noon or 3 PM remained unchanged. Among 1,034,515 discharges at 197 hospitals during the last 2 quarters of 2022, most discharges (P < 0.0001 versus 50%) occurred after 3 PM. The pooled incidence of discharges by noon was 13.2%, while the estimate of the incidence inverse weighted by the hospitals' counts of discharges was 13.3% (97.5% 12.6% to 14.1%). The corresponding pooled incidences of discharges by 3 PM was 42.5%, and 43.7% (97.5% confidence interval 42.3% to 45.2%). All 136,924 combinations of hospital and Medicare severity diagnosis-related groups were evaluated to examine why discharges did not occur earlier. Among the 1377 such combinations (1% of the total) with a significant change in median length of stay, 95% (1313) were decreases in lengths of stay. The implication is that the pandemic had no salutatory effect on earlier discharges. Therefore, post-anesthesia care unit managers should continue to plan for most hospital beds to be unavailable until late afternoon.