We all know discharge planning should start on day one. But it doesn't.
I surveyed my colleagues during a QI project and found that most physicians don't think about discharge until 24 hours before sending the patient home. The result? Last-minute scrambles for skilled nursing placement, oxygen equipment, and transportation—all delaying discharge and extending length of stay.
Every extra day costs the hospital money. Hospitals get paid a fixed DRG rate based on expected length of stay. A pneumonia patient might have an expected 3-day stay with $4,000 reimbursement. Day 4? Day 5? The hospital eats that cost while the bed sits occupied.
But it's not the patient's fault. It's operational failure. Delayed lab results. Patients scattered across different units. Procedure backlogs. Care management learning about discharge barriers too late to fix them.
Corewell Health West—a 10-hospital system with 100,000+ annual admissions—decided to actually fix this problem. They cut opportunity days from 47% to 28%. Average length of stay dropped from 6.1 to 5.3 days. They saved $30 million in 18 months.
And they did it without increasing readmissions or sacrificing patient experience scores.
How? By rebuilding the infrastructure around patient flow instead of departmental silos...
