1613 - Strengthening the Weak-End: Reducing Incomplete Weekend Discharges in Inpatient Rehabilitation Facilities (Quality Improvement Project)

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MS

Melissa Sun, DO, MS

Resident Physician / Physical Medicine and Rehabilitation
Penn State College of Medicine
Hummelstown, Pennsylvania, United States

Co-Author(s)

PG

Prateek Grover, MD, PhD, MHA

Associate Professor of PM&R and Biomedical Engineering (adjunct)
Penn State College of Medicine
Hershey, Pennsylvania, United States

Corresponding Author(s)

NR

Natasha Romanoski, D.O.

Associate Professor, Physical Medicine and Rehabilitation
Penn State College of Medicine
Hershey, Pennsylvania, United States

Submitter(s)

MS

Melissa Sun, DO

Penn State PM&R Program
Hummelstown, Pennsylvania, United States

Objectives: Incomplete weekend discharges in acute inpatient rehabilitation facilities (IRFs) decrease weekend workflow efficiency for the on-call team (one attending and one resident) who are responsible for all patients, admissions, and discharges. This QI project aimed to reduce incomplete discharges by 10% in six months through interventions discussed below.

Design: This project was conducted in a 98-bed IRF using the CQI-DIMER Toolkit. Incomplete weekend discharges, defined as any discharge requiring additional orders or medical management beyond placing the discharge order, was the primary metric. Fishbone and Pareto analyses identified incomplete handoffs and the absence of a systematic discharge checklist as key drivers. Two interventions were selected with a benefit–effort matrix: (1) a discharge readiness checklist to ensure all components were addressed before the weekend, and (2) a standardized EPIC dot phrase to improve provider communication. To assess impact, a nine-question standardized survey was distributed to on-call residents (n=9) 3-months pre- and post-intervention to assess self-reported data on workflow efficiency. Questions consisted of Likert scale (1 = strongly disagree, 5 = strongly agree), multiple choice, and free response. Incomplete discharge rates for a 3-month period pre- and post-intervention were calculated from total weekend discharges during the respective time frames and compared.

Results: In 3-months pre-intervention, 12% of all weekend discharges were incomplete. In 3-months post-intervention, this rate decreased to 4%. Survey responses were averaged and resulted in fewer reported workflow disruptions, with mean scores improving from 2.86 (SD 1.07, range 3.0) to 2.13 (SD 1.37, range 4.0). Prescription-related problems remained the most frequent cause for incomplete discharges.

Conclusions:
A discharge checklist and EPIC dot phrase improved workflow and reduced incomplete weekend discharges by 8% in three months, with room for further reduction by six months. Standardizing preparation and handoff processes decreased incomplete discharges and improved weekend workflow efficiency.