University of California Davis Health Emergency Department

Sacramento, California

The University of California Davis 89-bed emergency department’s “Discharge=Take Charge” initiative focuses on reducing patient discharge times by empowering bedside nurses to lead the discharge process. As a large, busy academic ED that saw 97,000 patient visits in 2023, there were often long wait times, and the ED staff members sought ways to improve throughput. A root cause analysis identified delays between the discharge decision and the patient’s actual departure, primarily because physicians often waited until all discharge requirements were met before initiating the process. A team of nurses, ED techs, physicians, and administrators gathered to address three key goals: streamline individual discharge processes, improve communication between providers and nurses, and give nurses more control over essential discharge tasks.

The team introduced a workflow where physicians mark patients as “conditionally discharged,” pending specific tasks or goals. This approach allows nurses to prioritize and manage the discharge process, typically 30- 120 minutes before the patient is ready to leave. The group also developed a dashboard that tracks 14 weeks of rolling data on key metrics like ED length of stay, discharged patient volume and conditional discharge volume. These metrics are reviewed daily and discussed monthly with the leadership team.