HospitalismNCT05370638
Discharge in the AM
A study testing Rounding on discharging patients first in people with Hospitalism and Flow or Discharge, run by University of Colorado, Denver at 1 site in United States.
Trial summary
As hospitals around the country continue to work to manage a high patient census, provider prioritization of discharges is one low cost mechanism to help improve patient throughput and patient length of stay. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Hospitalism, Flow or Discharge
- What is being tested?
- Rounding on discharging patients first
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 61 participants
- Where
- 1 siteUnited States
- Study dates
- 9 Feb 2021to 31 Jul 2021
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Physicians:
- -Hospital Medicine attending-level physicians who consented to participate and patients
- Patients:
- At least 18 years of age
- Admitted to a Medicine service and assigned by standard practice to a general medical hospitalist team including a provider who agreed to participate in the study
Who cannot join
- -Patients assigned, by standard practice, to a general medical hospitalist team and on the team of providers who chose not to participate in the study
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Discharge in the AM: A Randomized Controlled Trial of Physician Rounding Styles to Improve Hospital Throughput and Length of Stay
As hospitals around the country continue to work to manage a high patient census, provider prioritization of discharges is one low cost mechanism to help improve patient throughput and patient length of stay. The investigators conducted a prospective randomized study to understand if this commonly utilized approach to expedite care results in earlier discharges and lower hospital lengths of stay while also understanding the impact on other patient care (such as test and consult order times on other patients that the physician is caring for).
Read the detailed description
Hospitals around the country face bottlenecks and capacity issues. When hospitals are successful at managing high capacity this allows for increased access for patients who need this higher level of care and expertise.
Unfortunately, hospital discharges frequently occur in the afternoon or evening hours and can adversely affect patient flow throughout the hospital which, in turn, can result in delays in care, medication errors, increased mortality, longer lengths of stay, higher costs, lower patient satisfaction, and decreased access to care at these facilities. While some of the delays in discharges result, appropriately, from the caring of other patients and conducting the necessary tasks and assessments for acutely ill patients, previous work also identified that providers may be able to prioritize their work in a different way in order to facilitate this throughput. The investigators aim to conduct a randomized controlled trial of physician rounding style at three institutions in order to: (1) determine if prioritizing discharging patients first will result in earlier discharges and decreased lengths of stay, (2) determine if prioritizing discharges first will cause other care delays or affect patient experience and, (3) determine factors that contribute to physician ability to prioritizing discharges first. The study is a prospective, multi-center, cluster randomized trial designed to test the effects of rounding on discharging patients first compared to usual practice and will utilize an effectiveness-implementation hybrid approach. The investigators will recruit hospitalist attending physicians from three hospitals in the US to be randomized to one of two rounding styles: (1) prioritize discharges first and (2) usual practice. The main outcome measure will be discharge order time. Secondary outcomes will be length of stay and lab/diagnostic test order time. Additionally, the investigators will study how team composition (teaching, non-teaching, teams with advanced practice providers), team census (i.e. the number of patients a provider is caring for), and number of admissions affect the ability for providers to prioritize discharges first.
Through qualitative methods the investigators will also gain an understanding from physicians as to why or why not they were able to prioritize discharges first. This study will add to the evidence to either support or negate the practice of prioritizing discharges. There have been no randomized studies to date that have addressed these issues. Additionally, the investigators aim to understand how team composition and census affect discharge times. Institutions across the country will be able to utilize these findings to help refine current rounding models. The investigators believe these findings will be pivotal for clinicians to be more willing to change their practice style. The investigators also believe this study will aid in the understanding of what factors may function as facilitators and barriers of earlier discharges.
- Conditions
- Hospitalism, Flow or Discharge
- Being tested
- Rounding on discharging patients first
- Keywords
- hospitalist, patient flow, early discharge, discharge before noon, inpatient
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Rounding on discharging patients firstOther
Rounding on discharging patients meant that the attending physician and accompanying team (i.e. if they were working with advanced practice providers or learners) would prioritize seeing any patients that were going to discharge that day. The attending could break protocol if needed for patient care purposes and this was tracked each day.
| Study group | Role | What they receive |
|---|---|---|
| rounding on discharging patients first | Experimental | Rounding on discharging patients meant that the attending physician and accompanying team (i.e. if they were working with advanced practice providers or learners) would prioritize seeing any patients that were going to discharge that day. Receives: Other: Rounding on discharging patients first |
| usual practice | No intervention | Usual practice was categorized as: seeing discharging patients first, sickest patients, decompensating patients, new patients (i.e. patients admitted to their team overnight), or based on geography. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Physician discharge order time
Physician discharge order time entered into the electronic health record
Measured: From the midnight of the day the patient was discharged until time the patient had a discharge order placed, assessed up to 6 months from the start of the study.
Secondary outcomes (3)
Patient discharge time
The time the patient left their hospital bed/actually discharged from care in the hospital
Measured: From the midnight of the day the patient was discharged until the time the patient was discharged from the hospital, assessed up to 6 months from the start of the study.
Patient length of stay
The total length of stay in hours
Measured: From the time that the patient was admitted to hospital until time the patient had a discharge order placed, assessed up to 6 months from the start of the study.
Average time of day of orders for imaging, consults, or procedures were entered by participating physicians into the electronic health record
average time of day over the course of each patient's hospitalization that orders for imaging, consults, or procedures were entered by participating physicians
Measured: From the midnight of the day each day to the time of day each patient had an order placed for imaging, consults, or procedures, assessed up to 6 months from the start of the study.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 May 2022
- Study start9 Feb 2021
- Primary completion31 Jul 2021
- Study completion31 Jul 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for HospitalismStudies of the same condition, open and under way.
- More trials run by University of Colorado, DenverThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 61 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Colorado, Denver
- Sponsor type
- University, hospital or other
- Collaborators
- Denver Health and Hospital Authority, Johns Hopkins University
- Responsible party
- Sponsor
- Investigators
- Marisha Burden, MD, Principal investigator, University of Colorado School of Medicine
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05370638
- Sponsor's protocol ID
- 19-1607
- Status last verified
- May 2022
- First submitted
- 25 Apr 2022
- Last updated
- 11 May 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Burden M, Gundareddy VP, Kauffman R, Keach JW, McBeth L, Raffel KE, Rice JD, Washburn C, Kisuule F, Keniston A. Assessing the impact of workload and clinician experience on patient throughput: A multicenter study. J Hosp Med. 2025 May;20(5):471-478. doi: 10.1002/jhm.13555. Epub 2024 Nov 26.
PubMed 39588662
Study at a glance
From the registry record, last updated by the sponsor on 11 May 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Discharge in the AM: A Randomized Controlled Trial of Physician Rounding Styles to Improve Hospital Throughput and Length of Stay
- ClinicalTrials.gov ID
- NCT05370638
- Acronym / sponsor ID
- 19-1607
- Conditions
- Hospitalism, Flow or Discharge
- Keywords
- hospitalist, patient flow, early discharge, discharge before noon, inpatient
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 61 participants (actual)
- Lead sponsor
- University of Colorado, DenverUniversity, hospital or other
- Collaborators
- Denver Health and Hospital Authority, Johns Hopkins University
- Study start
- 9 Feb 2021 (actual)
- Primary completion
- 31 Jul 2021 (actual)
- Study completion
- 31 Jul 2021 (actual)
- First posted
- 11 May 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
As hospitals around the country continue to work to manage a high patient census, provider prioritization of discharges is one low cost mechanism to help improve patient throughput and patient length of stay. The investigators conducted a prospective randomized study to understand if this commonly utilized approach to expedite care results in earlier discharges and lower hospital lengths of stay while also understanding the impact on other patient care (such as test and consult order times on other patients that the physician is caring for).
Detailed description
Hospitals around the country face bottlenecks and capacity issues. When hospitals are successful at managing high capacity this allows for increased access for patients who need this higher level of care and expertise.
Unfortunately, hospital discharges frequently occur in the afternoon or evening hours and can adversely affect patient flow throughout the hospital which, in turn, can result in delays in care, medication errors, increased mortality, longer lengths of stay, higher costs, lower patient satisfaction, and decreased access to care at these facilities. While some of the delays in discharges result, appropriately, from the caring of other patients and conducting the necessary tasks and assessments for acutely ill patients, previous work also identified that providers may be able to prioritize their work in a different way in order to facilitate this throughput. The investigators aim to conduct a randomized controlled trial of physician rounding style at three institutions in order to: (1) determine if prioritizing discharging patients first will result in earlier discharges and decreased lengths of stay, (2) determine if prioritizing discharges first will cause other care delays or affect patient experience and, (3) determine factors that contribute to physician ability to prioritizing discharges first. The study is a prospective, multi-center, cluster randomized trial designed to test the effects of rounding on discharging patients first compared to usual practice and will utilize an effectiveness-implementation hybrid approach. The investigators will recruit hospitalist attending physicians from three hospitals in the US to be randomized to one of two rounding styles: (1) prioritize discharges first and (2) usual practice. The main outcome measure will be discharge order time. Secondary outcomes will be length of stay and lab/diagnostic test order time. Additionally, the investigators will study how team composition (teaching, non-teaching, teams with advanced practice providers), team census (i.e. the number of patients a provider is caring for), and number of admissions affect the ability for providers to prioritize discharges first.
Through qualitative methods the investigators will also gain an understanding from physicians as to why or why not they were able to prioritize discharges first. This study will add to the evidence to either support or negate the practice of prioritizing discharges. There have been no randomized studies to date that have addressed these issues. Additionally, the investigators aim to understand how team composition and census affect discharge times. Institutions across the country will be able to utilize these findings to help refine current rounding models. The investigators believe these findings will be pivotal for clinicians to be more willing to change their practice style. The investigators also believe this study will aid in the understanding of what factors may function as facilitators and barriers of earlier discharges.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| rounding on discharging patients first | Experimental | Other: Rounding on discharging patients firstRounding on discharging patients meant that the attending physician and accompanying team (i.e. if they were working with advanced practice providers or learners) would prioritize seeing any patients that were going to discharge that day. |
| usual practice | No intervention | –Usual practice was categorized as: seeing discharging patients first, sickest patients, decompensating patients, new patients (i.e. patients admitted to their team overnight), or based on geography. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (5 listed)
- -Hospital Medicine attending-level physicians who consented to participate and patients
- At least 18 years of age
- Admitted to a Medicine service and assigned by standard practice to a general medical hospitalist team including a provider who agreed to participate in the study
Key exclusion criteria (1 listed)
- -Patients assigned, by standard practice, to a general medical hospitalist team and on the team of providers who chose not to participate in the study
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Rounding on discharging patients firstRounding on discharging patients meant that the attending physician and accompanying team (i.e. if they were working with advanced practice providers or learners) would prioritize seeing any patients that were going to discharge that day. The attending could break protocol if needed for patient care purposes and this was tracked each day. | Other | rounding on discharging patients first |
Primary outcome
Physician discharge order time
Time frame: From the midnight of the day the patient was discharged until time the patient had a discharge order placed, assessed up to 6 months from the start of the study.
Physician discharge order time entered into the electronic health record
3 secondary outcomes
Patient discharge time
Time frame: From the midnight of the day the patient was discharged until the time the patient was discharged from the hospital, assessed up to 6 months from the start of the study.
Patient length of stay
Time frame: From the time that the patient was admitted to hospital until time the patient had a discharge order placed, assessed up to 6 months from the start of the study.
Average time of day of orders for imaging, consults, or procedures were entered by participating physicians into the electronic health record
Time frame: From the midnight of the day each day to the time of day each patient had an order placed for imaging, consults, or procedures, assessed up to 6 months from the start of the study.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 May 2022.
- Derived from this study: PubMed 39588662Burden M, Gundareddy VP, Kauffman R, Keach JW, McBeth L, Raffel KE, Rice JD, Washburn C, Kisuule F, Keniston A. Assessing the impact of workload and clinician experience on patient throughput: A multicenter study. J Hosp Med. 2025 May;20(5):471-478. doi: 10.1002/jhm.13555. Epub 2024 Nov 26.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Marisha Burden, MD principal investigator
University of Colorado School of Medicine
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Rounding on discharging patients first in people with Hospitalism and Flow or Discharge, run by University of Colorado, Denver at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 May 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Physician discharge order time (time frame: From the midnight of the day the patient was discharged until time the patient had a discharge order placed, assessed up to 6 months from the start of the study.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05370638, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 May 2022.