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Real-time operational feedback: daily discharge rate as a novel hospital efficiency metric
  1. Hannah J Wong1,2,3,
  2. Robert C Wu3,4,
  3. Michael Caesar2,3,
  4. Howard Abrams3,4,
  5. Dante Morra3,4
  1. 1Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
  2. 2Shared Information Management Services, University Health Network, Toronto, Ontario, Canada
  3. 3Centre for Innovation in Complex Care, University Health Network, Toronto, Ontario, Canada
  4. 4Division of General Internal Medicine, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Dante Morra, Toronto General Hospital, 200 Elizabeth Street, EN 14-218, Toronto, Ontario M5G 2C4, Canada; dante.morra{at}


Background Part of delivering quality care means providing it in a timely, efficient manner. Improving the efficiency of care requires measurement. The selection of appropriate indicators that are valid and responsive is crucial to focus improvement initiatives. Indicators of operational efficiency should be conceptually simple, generated in real time, calculated using readily available hospital administrative data, sufficiently granular to reveal detail needed to focus improvement, and correlate with other valid indicators of operational efficiency.

Discussion In this paper, the authors propose daily discharge rate as a novel real-time metric of hospital operational discharge efficiency and compare it with average length of stay. The authors also suggest the use of control charts as an effective way to present daily discharge rate data to clinicians and managers in real time to prompt actionable improvements in discharge efficiency.

Conclusion The authors conclude that daily discharge rate has the potential to drive timely improvements in the discharge process and warrants consideration and further study by others interested in improving hospital operational efficiency and the delivery of quality care.

  • Efficiency
  • metric
  • discharge
  • control chart
  • real-time
  • collaborative, communication
  • continuous quality improvement
  • healthcare quality improvement
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  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University Health Network Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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