Improving the Quality of Written Discharge Instructions: A Multisite Collaborative Project.

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Pediatric Healthcare

Background:

• Written discharge instructions are crucial for patient and family transitions from hospital to home.
• Significant variability exists in the quality of pediatric written discharge instructions.
• The Institute for Healthcare Improvement (IHI) Virtual Breakthrough Series (VBS) collaborative aims to improve healthcare processes.

Purpose of the Study:

• To evaluate the impact of participation in an IHI VBS collaborative on the quality of pediatric written discharge instructions.
• To assess if baseline hospital performance influences the effectiveness of the quality improvement collaborative.

Main Methods:

• A multicenter, interrupted time-series analysis was conducted across 8 US hospitals.
• A medical records-based quality measure (0-100 scale) assessed discharge instruction content quality.
• Data included 5739 pediatric patients sampled across pre-collaborative, collaborative, and post-collaborative phases (2015-2020).

Main Results:

• Hospitals with high baseline performance showed significant improvements in discharge instruction quality during the collaborative phase (+0.7 points/month).
• Hospitals with low baseline performance also improved, but at a slower rate than expected from pre-collaborative trends (-0.5 points/month).
• Statistical significance was observed for both high-performing (P < .001) and low-performing (P < .01) groups.

Conclusions:

• Participation in the IHI VBS collaborative improved pediatric written discharge instruction quality.
• Improvement was significantly associated with baseline hospital performance; high-performing hospitals benefited more.
• Targeted strategies may be needed to optimize collaborative benefits for lower-performing institutions.