A Quality Improvement Approach to Early Patient Discharge

Lack of bed availability is a common problem in our pediatric unit, as in many hospitals. To address this issue, we instituted a quality improvement (QI) initiative involving collaborative nurse-physician rounding. This intervention has been shown to expedite discharge, improve patient care, and increase bed availability in other settings.

By utilizing PDCA (Plan, Do, Check, Act) processes, we created two improvement initiatives, "Increasing Patient Discharge Before 12 pm" and "Midnight Rounds with Discharge Focus." Senior resident and faculty physicians rounded on discharge-ready patients before teaching rounds, and by 10 am, placed discharge orders to allow for a 12 pm discharge. A night team consisting of senior residents and nurses conducted "Midnight Rounds" and identified potential discharges for the morning team. The project aimed to increase patient discharges before 12 pm from a June-November 2018 baseline of 15%-20% by June 2019.

Patient discharge percentage before 12 pm increased from 15% to 21% (P < 0.01) by June 2019, and as a result, bed availability increased by 16% (P < 0.01).

QI methodology clarified the root causes of limited bed availability. Understanding the existing discharge process allowed for QI initiatives to develop a consistent and sustainable discharge process. Patient discharge percentages before 12 pm increased by 40%, and bed availability increased by 16% after QI implementations.