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Enhancing Hospital Throughput: A Multidisciplinary Approach to Facilitating Discharges in a Pediatric Setting
Meghan W Harrison1, Adolfo L Molina2, Chang L Wu3
1From the MSHA, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Insights
Children's hospitals can improve patient flow by shifting afternoon discharges to off-peak hours. This strategy increased non-peak discharges by 8% without affecting patient satisfaction or length of stay.
Area of Science:
- Pediatrics
- Hospital Administration
- Healthcare Operations
Background:
- Postpandemic surges in respiratory viral illnesses strained pediatric inpatient capacity.
- Afternoon discharge clustering was identified as a significant bottleneck in patient throughput.
- Improving discharge efficiency is crucial for optimizing hospital resource utilization.
Purpose of the Study:
- To increase the percentage of patients discharged outside of peak afternoon hours (11 am-5 pm).
- To enhance hospital throughput efficiency and bed availability.
- To promote timely discharges when patients are medically ready.
Main Methods:
- An interdisciplinary committee analyzed discharge data (Jan 2021-Apr 2022) to identify peak hours.
- Plan-do-study-act cycles were used to trial interventions targeting discharge timing.
- Statistical process control charts (p-charts) monitored the primary outcome: non-peak discharges.
Main Results:
- The percentage of non-peak discharges (5 pm-11 am) rose from 28% to 36%.
- Discharges before 11 am increased from 7% to 19%; early morning orders (before 9 am) rose from 4% to 16%.
- No significant changes were observed in average length of stay, discharge turnover time, or patient satisfaction.
Conclusions:
- Interventions successfully increased the proportion of pediatric patients discharged during non-peak hours.
- The initiative facilitated earlier discharges when patients were medically cleared.
- Workflow adjustments and stakeholder engagement were key to successful implementation.
Introduction:
Recent postpandemic respiratory viral surges have highlighted challenges in inpatient capacity at children's hospitals. Our hospital identified a key bottleneck affecting our ability to accommodate patients: afternoon discharge clustering. We sought to improve throughput efficiency by increasing the percentage of patients discharged outside peak hours.
Methods:
We established an interdisciplinary committee to study our discharge process. We obtained baseline data from January 2021 to April 2022 and determined our peak discharge hours, 11 am-5 pm, when 72% of discharges occurred. Key drivers were identified using the model for improvement, and interventions were trialed using plan-do-study-act cycles. Percent of patients discharged outside peak hours was determined using statistical process control charts (p-charts) as our primary measure. We aimed to improve this percentage by 20% from baseline. Secondary measures were the percentage of discharge orders placed before 9 am and the percentage of patients discharged before 11 am. Balancing measures included average hospital length of stay, discharge turnover time, and patient satisfaction surveys.
Results:
The mean percentage of nonpeak discharges between 5 pm and 11 am increased from a baseline of 28% to 36%. Discharge orders placed before 9 am increased from 4% to 16%. Patients discharged before 11 am increased from 7% to 19%. There were no significant changes in length of stay, discharge turnover time, or patient satisfaction with the discharge process. Key interventions included stakeholder involvement and incentives to support faculty and trainee workflow adjustments, including rounding practices.
Conclusions:
Our team increased the percentage of patients discharged during nonpeak hours and promoted discharge when medically ready.
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