Abstract
<title>Abstract</title> <p>Objective To evaluate whether a standardized communication and documentation process improved the completeness of the interval between the intensive care unit discharge decision and actual unit exit, enabling reliable measurement of avoidable unit days. Methods This before-and-after quality improvement study compared aggregated electronic registry reports from two 10-bed adult intensive care units in January-June 2025 and January-June 2026. The primary outcome was the proportion of survivors with a classifiable decision-to-exit interval. Secondary outcomes were exit within four hours, avoidable unit days, and balancing measures. Results There were 1,105 admissions at baseline and 1,132 after implementation. At baseline, the interval was not calculable in the cardiac unit and only 0.27% of records were classifiable in the general unit. After implementation, completeness reached 95.83% and 94.07%, respectively (95.2% combined). Exit within four hours occurred in 93.24% of survivors in the cardiac unit and 86.34% in the general unit. The registry identified 17.9 avoidable unit days (rate, 1.4%) and 26.1 days (1.8%), respectively. Seventy-two-hour readmission did not increase. Conclusion Standardized communication and documentation were associated with recovery of a reliable discharge-flow measure and made previously unquantifiable delays visible. Critical baseline missingness precludes a direct conclusion that avoidable unit days decreased.</p>