Using quality improvement to optimise paediatric discharge efficiency.

Area of Science:

• Healthcare Management
• Hospital Operations
• Patient Flow Optimization

Background:

• Inefficient hospital bed capacity management and delayed patient discharges negatively impact overall patient flow.
• Lack of standardized discharge criteria at the institution led to unpredictable discharge timing and prolonged delays.
• National recommendations emphasize timely and efficient patient care delivery.

Purpose of the Study:

• To increase the percentage of Hospital Medicine patients discharged within 2 hours of meeting discharge criteria from 42% to a target of 80%.
• To improve hospital efficiency and patient throughput through standardized discharge processes.

Main Methods:

• Developed medically appropriate discharge criteria for 11 common inpatient diagnoses, integrated into electronic medical record (EMR) order sets.
• Implemented strategies focused on completing discharge tasks before patients met criteria, including pharmacy process redesign and improved subspecialty consult timeliness.
• Utilized statistical process control charts to monitor interventions and compared length of stay (LOS) and readmission rates pre- and post-implementation.

Main Results:

• Achieved a significant improvement in timely discharges, increasing from 42% to 80% within 18 months.
• Reduced median overall length of stay (LOS) from 1.56 to 1.44 days (p=0.01) without a significant increase in readmission rates (4.60% to 4.21%; p=0.24).
• Observed an 18% increase in average hospital unit occupancy, from 36.4 to 42.9 patients.

Conclusions:

• Standardizing discharge goals and implementing high-reliability interventions effectively reduced patient length of stay (LOS).
• The process improvements successfully enhanced hospital capacity and patient throughput without compromising patient safety, as evidenced by stable readmission rates.