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Improving Discharge Efficiency in Medically Complex Pediatric Patients
Angela M Statile1, Amanda C Schondelmeyer2, Joanna E Thomson2
1Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio angela.statile@cchmc.org.
Insights
Streamlining hospital discharge for children with medical complexity is crucial. A multidisciplinary team improved timely discharges by 38%, ensuring readiness for home care.
Area of Science:
- Pediatrics
- Healthcare Quality Improvement
- Hospital Medicine
Background:
- Children with medical complexity present unique discharge challenges.
- Effective hospital-to-home transitions require coordinated family, education, equipment, and medication preparation.
- Current discharge processes often delay transitions for these vulnerable patients.
Purpose of the Study:
- To increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%.
- To improve the efficiency of discharge planning for pediatric patients with complex medical needs.
Main Methods:
- Quality improvement methodologies were employed to identify key drivers and implement interventions.
- Interventions included a dedicated complex care inpatient team, electronic order sets, weekly care coordination rounds, a needs assessment tool, and a standardized medication pathway.
- The primary outcome measure was the percentage of patients discharged within 2 hours of meeting medical discharge goals, tracked via run charts.
Main Results:
- The percentage of timely discharges improved from 50% to 88% over 17 months, with sustained results for 6 months.
- Median length of stay did not significantly change (3.1 vs 2.9 days; P = .67).
- The 30-day readmission rate remained statistically similar (30.7% vs 26.4%; P = .51).
Conclusions:
- A multidisciplinary team approach is essential for efficient discharge of medically complex patients.
- Proactive identification and addressing of discharge needs by the care team ensures patient readiness.
- Optimizing discharge processes can improve efficiency without negatively impacting readmission rates or length of stay.
Background And Objective:
Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%.
Methods:
We used quality improvement methods to identify key drivers and inform interventions. Medical discharge goals were defined on admission for each patient. Interventions included implementation of a complex care inpatient team with electronic admission order set, weekly care coordination rounds, needs assessment tool, and medication pathway. The primary measure, percentage of patients discharged within 2 hours of meeting medical discharge goals, was followed on a run chart. The secondary measures, pre- and post-intervention length of stay and 30-day readmission rate, were compared by using Wilcoxon rank-sum and χ(2) tests, respectively.
Results:
The percentage of medically complex patients discharged within 2 hours of meeting medical discharge goals improved from 50% to 88% over 17 months and sustained for 6 months. In preintervention-postintervention comparison, median length of stay did not change (3.1 days [interquartile range, 1.8-7.0] vs 2.9 days [interquartile range, 1.7-6.1]; P = .67) and 30-day readmission rate was not impacted (30.7% vs 26.4%; P = .51).
Conclusions:
Efficient discharge for medically complex patients requires support of a multidisciplinary team to proactively address discharge needs, ensuring patients are ready for discharge when medical goals are met.
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