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Objective: To define the relationship between discharge time of day, 30-day readmissions, and Hospital Consumer Assessments of Health Care Providers and Systems (HCAHPS) survey scores. Design: Retrospective cohort
Setting: Tertiary care academic medical center
Patients: From July 2016 to January 2017 a total of 1,471 patients were discharged from two surgical units. Of these, 362 (24.6%) completed HCAHPS responses were evaluated representing discharges from General Surgery (n=191, 52.8%), Thoracic Surgery (n=51, 14.1%), Urology (n=46, 12.7%), and Vascular Surgery (n=74, 20.4%). Interventions: NA Main Outcome Measures: The primary endpoints were the percent top-box response, or best possible response, for the HCAHPS domain related to “speed of discharge” (single question on the speed of the discharge process) and 30-day readmissions. The primary exposure was actual discharge time of day. Secondary analyses included the relationship between “discharge” and “care transition” responses (five questions addressing a hospital’s ability to prepare patients for discharge and patient comprehension of instructions) and 30-day readmissions. Results: The percent top-box response for “speed of discharge” was 54.6% among all patients. Those discharged prior to 2PM were nearly twice as likely to give a top-box response (OR 1.91, CI 1.219-3.006, p<0.01), indicating that earlier discharges appropriately improved the patient’s perception of a timely discharge. In addition, those readmitted were more likely to be discharged later (3PM vs. 2PM, p=0.03). We found no relationship between “discharge” or “care transition” responses and 30-day readmissions. Conclusions: Patients discharged earlier in the day are more likely to respond favorably on the HCAHPS survey, and less likely to require readmission within 30-days. These patients may represent a population that is less complex and/or better prepared to leave the hospital.