When I was a case manager on the floors, it became apparent to me that patients had no idea that the hospital encouraged them to leave before 12 noon. There is nothing in their admit paperwork that addresses this idea and I have yet to hear a physician push for this when discussing discharge with their patients. Yet, this is a goal year after year of the hospital. There are several simple fixes for this problem.

1. Include the language in the admit paperwork (which patient usually read after they are discharged), if ever. I used to do home infusion visits to visit patients after their discharge from UCSF and none of the patients had ever even looked at their paperwork.

2. When the case manager makes initial contact with the patient, address the feasibility of a noon discharge. The patient can then call family and give them advance notice that this is the expectation. The nurse caring for the patient should also advise a pick up before noon when the patient discusses discharge with her/him.

3. Since patient don't remember that much that we present to them, how about a neon or brightly colored laminated sign on their wall next to the clock in their room? It could be a funny cartoon showing them in a wheelchair going out the door with 12:00 Noon displayed prominently. That way when they look at the clock when determining what time they will be leaving, they will see the reminder.

One way or another, we need to find idea's to inform patients that a morning discharge is expected. Of course this means that the teams have to get their discharge paperwork together but most services know this from the case manager on rounds. We can't have patients waiting around until 6:00 when their friend gets off work to pick them up. I know they can be discharged and sent down to the waiting room/lobby but wouldn't it be a more pleasant experience if they went home instead of hanging out for hours? Or we could pay for a taxi voucher (which we do sometimes) but really a patient should be responsible for getting themselves home when physically able. 

Personally I like the sign idea.