The impact of discharge decisions on health care quality

In this paper, we present a normative study that describes the impact of discharging decisions in the face of resource shortages. We develop a model that represents the dynamics of a health care unit. Then, to capture the essence of discharge decisions, we consider discharge policies that incorporate both the occupancy level of the unit and the status of patients measured by their stage of recovery and the time they have spent in that stage. We believe that our model can be used as an aid to physicians and administrators to better assess discharge and/or capacity decisions. In addition, we investigate the impact of discharge decisions on the measures that represent the quality of care at a facility such as average hospital stays, system accessibility, and average complication risk of discharged patients. Our findings illustrate that inclusion of early discharge option improves system accessibility significantly and does not jeopardize care equity among patients. Furthermore, introduction of early discharge option has more pronounced effects on increasing care unit capacity than addition of open beds with no early discharges.