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A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children
Susan Wu1, Amy Tyler2, Tina Logsdon3
1Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California; suwu@chla.usc.edu.
Insights
Quality improvement collaboratives reduced pediatric discharge failures and improved family readiness. However, readmission rates did not significantly improve, indicating a need for further research on effective interventions.
Area of Science:
- Pediatric Healthcare Quality Improvement
- Patient Discharge Processes
- Healthcare Management
Background:
- Pediatric discharge processes are complex and prone to errors, impacting patient outcomes and family satisfaction.
- Quality improvement collaboratives offer a structured approach to enhance healthcare delivery and efficiency.
- Standardized discharge protocols are crucial for ensuring patient safety and successful transitions from hospital to home.
Purpose of the Study:
- To evaluate the effectiveness of a quality improvement collaborative in improving the quality and efficiency of pediatric discharges.
- To assess the impact of collaborative interventions on discharge-related care failures and family readiness.
- To analyze changes in 72-hour and 30-day readmission rates following the collaborative.
Main Methods:
- A multicenter quality improvement collaborative involving 11 children's hospitals in the US.
- Sites implemented interventions from a change package using plan-do-study-act cycles.
- Data collection included discharge failures, family readiness, and readmission rates.
Main Results:
- A significant decrease in discharge-related care failures (34% to 21%) was observed (P < .05).
- Family perception of readiness for discharge significantly improved (85% to 91%) (P < .05).
- No significant improvement in 72-hour readmissions (0.7% vs 1.1%) and a slight worsening in 30-day readmissions (4.5% vs 6.3%) were noted.
Conclusions:
- The quality improvement collaborative successfully reduced discharge failures and enhanced family readiness for pediatric patients.
- The collaborative did not lead to a significant reduction in unplanned readmissions.
- Further research is needed to identify the most effective interventions and their applicability in non-pediatric settings.
Objective:
To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges.
Methods:
This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies.
Results:
Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05).
Conclusions:
Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings.
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