Seventy-two-hour Return Initiative: Improving Emergency Department Discharge to Decrease Returns.

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Quality Improvement
• Patient Discharge Processes

Background:

• Unscheduled return visits within 72 hours of pediatric emergency department (ED) discharge are a significant quality indicator.
• These return visits constitute 4% of annual pediatric ED visits.

Purpose of the Study:

• To reduce the rate of unexpected 72-hour return visits in a network of pediatric EDs and urgent cares (UCs).
• To improve patient discharge processes to minimize readmissions.

Main Methods:

• A multidisciplinary team implemented a quality improvement initiative using Plan-Do-Study-Act cycles.
• Interventions included standardizing electronic health record discharge workflows, implementing 'mini-after care instructions,' and teach-back education.
• Statistical process control charts and chi-square tests were used to analyze the 72-hour return rate.

Main Results:

• The baseline 72-hour return rate was 3.5% before interventions.
• Following the implementation of 'mini-after care instructions,' there was an 8.2% reduction in the 72-hour return rate (P < 0.01).
• The improvements are estimated to prevent 600 ED/UC visits annually across the network.

Conclusions:

• Quality improvement methodologies significantly decrease 72-hour return rates in pediatric EDs and UCs.
• Multidisciplinary enhancement of discharge processes is effective in reducing unscheduled return visits.