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Facilitating the Timely Discharge of Well Newborns by Using Quality Improvement Methods
Nicole T Rochester1,2,3, Laurie P Banach1,2,3, Wendy Hoffner1,2,3
1Division of Hospital Medicine, Children's National Health System, Washington, District of Columbia.
Insights
Implementing a discharge checklist significantly improved early discharge orders for newborns, increasing the percentage from 24% to 39%. This enhanced hospital throughput for pediatric services.
Area of Science:
- Pediatrics
- Hospital Administration
- Healthcare Management
Background:
- Hospital discharges are critical for patient flow and resource management.
- Pediatric hospitalist teams aim to optimize newborn nursery throughput.
- Early discharge orders by 11 am are a key performance indicator.
Purpose of the Study:
- To enhance newborn nursery throughput by increasing early discharge orders.
- To evaluate the impact of a discharge checklist on newborn discharge times.
- To identify and mitigate barriers to timely newborn discharges.
Main Methods:
- Identified discharge barriers through stakeholder focus groups and chart reviews.
- Implemented a discharge checklist to address barriers before daily rounds.
- Tracked mean monthly discharge order times and modified rounding practices.
Main Results:
- Early discharge orders by 11 am increased from 24% to 39% post-intervention (a 63% rise).
- The intervention period covered 3224 newborns at baseline and 2739 newborns post-intervention.
- Group B Streptococcus exposure observation was the primary cause of delayed discharge orders.
Conclusions:
- A discharge checklist effectively improved the rate of early discharge orders for newborns.
- Optimizing discharge processes enhances hospital throughput in pediatric services.
- Further research into non-physician barriers can improve labor and delivery unit efficiency.
Background And Objectives:
Discharges are a key driver of hospital throughput. Our pediatric hospitalist team sought to improve newborn nursery throughput by increasing the percentage of newborns on our service with a discharge order by 11 am. We hypothesized that implementing a discharge checklist would result in earlier discharge times for newborns who met discharge criteria.
Methods:
We identified barriers to timely discharge through focus groups with key stakeholders, chart reviews, and brainstorming sessions. We subsequently created and implemented a discharge checklist to identify and address barriers before daily rounds. We tracked mean monthly discharge order times. Finally, we performed chart reviews to determine causes for significantly delayed discharge orders and used this information to modify rounding practices during a second plan-do-study-act cycle.
Results:
During the 2-year period before the intervention, 24% of 3224 newborns had a discharge order entered by 11 am. In the 20 months after the intervention, 39% of 2739 newborns had a discharge order by 11 am, a 63% increase compared with the baseline. Observation for group B Streptococcus exposure was the most frequent reason for a late discharge order.
Conclusions:
There are many factors that affect the timely discharge of well newborns. The development and implementation of a discharge checklist improved our ability to discharge newborns on our pediatric hospitalist service by 11 am. Future studies to identify nonphysician barriers to timely newborn discharges may lead to further improvements in throughput between the labor and delivery and maternity suites units.
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