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Using quality improvement to optimise paediatric discharge efficiency
  1. Christine M White1,
  2. Angela M Statile1,
  3. Denise L White2,
  4. Dena Elkeeb1,
  5. Karen Tucker3,
  6. Diane Herzog2,
  7. Stephen D Warrick4,
  8. Denise M Warrick4,
  9. Julie Hausfeld3,
  10. Amanda Schondelmeyer1,
  11. Pamela J Schoettker2,
  12. Pamela Kiessling3,
  13. Michael Farrell5,
  14. Uma Kotagal2,
  15. Frederick C Ryckman6
  1. 1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  4. 4Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  5. 5Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  6. 6Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Dr Christine White, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; christine.white{at}cchmc.org

Abstract

Background Bed capacity management is a critical issue facing hospital administrators, and inefficient discharges impact patient flow throughout the hospital. National recommendations include a focus on providing care that is timely and efficient, but a lack of standardised discharge criteria at our institution contributed to unpredictable discharge timing and lengthy delays. Our objective was to increase the percentage of Hospital Medicine patients discharged within 2 h of meeting criteria from 42% to 80%.

Methods A multidisciplinary team collaborated to develop medically appropriate discharge criteria for 11 common inpatient diagnoses. Discharge criteria were embedded into electronic medical record (EMR) order sets at admission and could be modified throughout a patient's stay. Nurses placed an EMR time-stamp to signal when patients met all discharge goals. Strategies to improve discharge timeliness emphasised completion of discharge tasks prior to meeting criteria. Interventions focused on buy-in from key team members, pharmacy process redesign, subspecialty consult timeliness and feedback to frontline staff. A P statistical process control chart assessed the impact of interventions over time. Length of stay (LOS) and readmission rates before and after implementation of process measures were compared using the Wilcoxon rank-sum test.

Results The percentage of patients discharged within 2 h significantly improved from 42% to 80% within 18 months. Patients studied had a decrease in median overall LOS (from 1.56 to 1.44 days; p=0.01), without an increase in readmission rates (4.60% to 4.21%; p=0.24). The 12-month rolling average census for the study units increased from 36.4 to 42.9, representing an 18% increase in occupancy.

Conclusions Through standardising discharge goals and implementation of high-reliability interventions, we reduced LOS without increasing readmission rates.

  • Hospital Medicine
  • Paediatrics
  • Communication
  • Healthcare Quality Improvement
  • Teamwork

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