We've been told to try and get our patients discharged before 11AM.
In fact-- we've been promised CUPCAKES if our team gets the most patients discharged before 11AM.
(This is not sufficient incentive to do anything, by the way.)
See, the hospital wants patients out early so they can get as many new patients admitted as early as possible, to start making money on them. Patients about to be discharged don't have procedures the day of discharge, so there's no money to make. Earlier they leave, the better.
But as soon as someone like me discharges a patient, we have room to get a new one-- and the last thing we want is to get four or five or six new patients in a day, and have to deal with all of those admissions notes.
So, in a perfect world, from my point of view, I want to discharge my patients late in the day, so there isn't time for me to get new ones. Since I'm not allowed to be given new admissions after 4:00 (they go to a different service), my goal is to keep all of my patients until 4:00, and then discharge them afterwards.
Of course, then I end up getting overnight admissions... which still take time the next morning... but not as much time, because someone has done some of the work for me overnight.
If the hospital wanted to align incentives, perhaps they could pass along some of the money they would gain along to residents like me... you want to pay me $200 for everyone I discharge before 11AM, suddenly you would see a lot more early discharges. $100, even. Maybe $75.
But for a chance at cupcakes? No thanks. I'll buy a cupcake if I want a cupcake.
(But I won't buy it from the kiosk in the lobby, because the kiosk in the lobby just got closed by the health department. Would you feel comfortable being a patient in a hospital that can't keep its lobby kiosk sanitary enough to remain open? Hint: YOU SHOULDN'T.)