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  1. Akshata Hopkins,
  2. Matthew Morrow
  1. Johns Hopkins All Children's Hospital, USA


Background Delays in the discharge process impact patient flow and lead to increased costs and slower progression of care. As hospitalist work becomes increasingly shift based, there are concerns regarding patient handoffs and hesitancy with clinical progression overnight.

Objectives We developed a 24 hour care progression bundle to improve nursing and physician handoff, promote 24/7 clinical care and validate a true-shared mental model of care. By implementing a Care Progression Bundle,we aimed to decrease the time to discharge by 25% and decrease average length of stay (LOS) by 20% in a 6-month period.

Methods A multidisciplinary group developed and implemented a Care Progression Bundle at a tertiary care free standing children's hospital using iterative Plan-Do-Study-Act cycles. We compared average LOS,mean time of discharge and discharge time six months prior (N=601 patients from Sept 2014–Feb 2015) and six months post implementation (N=616 patients from April 2015–Sept 2015).

Results Discharge time decreased by 30% from 2.45 hrs during the pre-intervention period to 1.76 hrs post-intervention (p=0.001). Average LOS significantly decreased from 80 hrs to 57.3 hrs (p=0.003). The average discharge time of day was significantly earlier (p<0.001). The 30-day readmission rate remained similar between pre and post implementation.

Conclusions The Care Progression Bundle safely decreased LOS and time to discharge without increasing utilization of resources. Culture change towards a more unified shared mental model was a challenge but positive results are helping to shift to more acceptance of the 24 hour clinical progression of care. Next steps will be to measure physician and nursing satisfaction, analyze patient experience and perform an accurate cost analysis.

Figure 1

Detailed description of the 24 hour care progression bundle.

Figure 2

Discharge time (order to depart) pre and post Care Progression Bundle implementation.

  • Accreditation
  • Anaesthesia
  • Attitudes

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