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Addressing the Inpatient Capacity Crunch: A Quality Improvement Initiative to Increase Expected Discharge Date
Insights
Implementing expected discharge date (EDD) documentation improved pediatric hospital communication and data for capacity management, though length of stay (LOS) remained unchanged.
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.
Introduction:
Pediatric hospital capacity has decreased nationally, leaving hospitals vulnerable to capacity constraints. Approximately one fourth of pediatric patients experience discharge delays secondary to poor planning and miscommunication. As part of a hospitalwide quality improvement effort to decrease length of stay (LOS) through improved communication, an interdisciplinary team sought to increase expected discharge date (EDD) documentation for discharges on six low-performing teams from 14.2% to 50% by February 2023, inclusive of Child Opportunity Index (COI).
Methods:
The team identified three primary drivers of EDD documentation: knowledge, logistics, and competing priorities. Interventions to address these drivers were implemented through eight Plan-Do-Study-Act cycles and the impact analyzed via statistical process control charts. Measures included EDD documentation (primary outcome measure), LOS (secondary outcome measure), discussion of the EDD per patient (process measure), rounding time, discharge by noon, and EDD accuracy (balancing measures).
Results:
A total of 18,889 discharges were included during the baseline (July 2021 to August 2022) and intervention (September 2022 to August 2024) periods. EDD documentation demonstrated special cause variation, increasing from 14.2% to 55.7%, and was sustained for 20 months. Improvement was consistent across COI with 93.94% accuracy. LOS and rounding time were unchanged. Discussion of the EDD per patient decreased from 38.9% to 29.4%.
Conclusion:
Although this effort did not decrease LOS, EDD documentation increased. This provided real-time data for more than 12,000 discharges during the intervention period. EDD documentation may serve as a valuable tool for institutional leaders to inform capacity management strategy.
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