Addressing the Inpatient Capacity Crunch: A Quality Improvement Initiative to Increase Expected Discharge Date...

Area of Science:

• Healthcare Management
• Quality Improvement
• Pediatric Hospital Operations

Background:

• Pediatric hospital capacity is strained nationally, leading to vulnerability.
• Discharge delays affect approximately 25% of pediatric patients due to poor planning and communication.
• A quality improvement initiative aimed to enhance communication and reduce length of stay (LOS).

Purpose of the Study:

• To increase the documentation of expected discharge dates (EDD) for pediatric discharges.
• To improve communication and potentially reduce length of stay (LOS) in pediatric hospitals.
• To achieve 50% EDD documentation across six low-performing teams by February 2023.

Main Methods:

• Identified drivers of EDD documentation: knowledge, logistics, and competing priorities.
• Implemented interventions through eight Plan-Do-Study-Act cycles.
• Analyzed impact using statistical process control charts, measuring EDD documentation, LOS, and EDD accuracy.

Main Results:

• EDD documentation increased from 14.2% to 55.7%, sustained for 20 months.
• Improvement in EDD documentation was consistent across Child Opportunity Index (COI) levels with 93.94% accuracy.
• Length of stay (LOS) and rounding time remained unchanged; discussion of EDD per patient decreased.

Conclusions:

• The initiative successfully increased EDD documentation, providing valuable real-time data.
• EDD documentation can inform institutional leaders for capacity management strategies.
• While LOS was not reduced, the increase in EDD documentation offers a tool for operational improvement.