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Quality improvement strategies improve pediatric neurology inpatient discharges before noon
Padmavati Eksambe1, Yash D Shah1, Kanwaljit Singh1
1Division of Child Neurology, Department of Pediatrics (PE, YDS, JS, EL, RMSK, JK, CA, S. Karkare, S. Kothare), Cohen Children's Medical Center, New Hyde Park, NY; and Department of Pediatrics (KS), University of Massachusetts Medical School, Worcester, MA.
Insights
Implementing quality improvement strategies significantly increased early hospital discharge for pediatric neurology patients. Discharge before noon (DBN) rates rose from 40.7% to 60.8%, improving patient flow.
Area of Science:
- Pediatric Neurology
- Quality Improvement Science
- Healthcare Management
Background:
- Early hospital discharge is a key quality improvement (QI) metric in healthcare.
- Its impact on pediatric neurology patient flow remains understudied.
- This study aimed to enhance discharge efficiency in pediatric neurology.
Purpose of the Study:
- To implement and evaluate strategies for improving hospital discharge times for pediatric neurology patients.
- To increase the rate of discharge before noon (DBN) in this patient population.
Main Methods:
- A pilot quality improvement (QI) study was conducted over six months in a tertiary care children's hospital.
- Interventions included pre-identifying MRI candidates, streamlining home care referrals, optimizing pharmacy coordination, and implementing morning huddles.
- Data analysis involved chi-square, t-tests, and survival analysis to compare pre- and post-intervention periods.
Main Results:
- A total of 191 pediatric neurology patients were included (76 pre-intervention, 115 post-intervention).
- The percentage of patients discharged before noon (DBN) increased from 40.7% to 60.8% post-intervention.
- Survival analysis confirmed a statistically significant improvement in discharge times (p=0.043).
Conclusions:
- The study successfully identified factors contributing to delayed discharges in pediatric neurology.
- Effective strategies were developed and implemented to improve DBN rates.
- These QI initiatives demonstrate potential for optimizing inpatient pediatric neurology care pathways.
Background:
Early hospital discharge is an important quality improvement (QI) measure that has not been well studied in pediatric neurology. The objective of our study was to implement strategies to improve hospital discharge times for patients admitted to the pediatric neurology service.
Methods:
This was a pilot QI study of hospital discharge before noon (DBN) in pediatric neurology patients admitted to a tertiary care children's hospital. The study duration was 6 months (12/2017-05/2018)-first 3 months preintervention and next 3 months postintervention. Strategies focusing on preidentifying MRI candidates and those needing home care services, identifying pharmacy preference, reviewing overnight video EEGs first thing in the morning, and implementing morning huddles, etc., were implemented. Demographic and clinical data were collected, including age, sex, race, and reasons for delay in discharge. Chi-square, t test, and survival analysis (log-rank test) were performed to determine differences between baseline and post-QI implementation.
Results:
One hundred ninety-one patients were included in the study. There were 76 participants before the implementation of the study and 115 participants during the study. DBN percentage increased in the intervention period, from a baseline of 40.7% to 60.8%. Survival analysis showed that the discharge time after QI implementation improved significantly (p = 0.043).
Conclusions:
Our study successfully identified the factors associated with late discharge and developed effective strategies to improve DBN in an inpatient pediatric neurology setting.
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