Improved Documentation of a Pediatric Phase II Postanesthesia Discharge Scoring Tool: A Quality Improvement Project
Amy Berardinelli1, Katelyn Howell2, Margaret Allen3
1Perioperative Services, Akron Children's Hospital, Akron, OH.
Insights
A new standardized scoring tool improved pediatric discharge readiness assessments in ambulatory surgery. The pediatric readiness for discharge (P-REDI) tool saw 78.4% registered nurse usage, ensuring safe patient transitions.
Area of Science:
- Perianesthesia Nursing
- Quality Improvement Science
- Pediatric Healthcare
Background:
- The American Society of PeriAnesthesia Nurses advocates for standardized discharge scoring tools for safe patient transitions.
- A freestanding pediatric hospital identified a lack of standardized tools for assessing pediatric readiness for discharge after ambulatory surgery.
- This gap highlighted the need for a consistent, objective method to ensure patient safety during postanesthesia care transitions.
Purpose of the Study:
- To implement a standardized discharge scoring tool to ensure safe, consistent, and efficient patient care for pediatric ambulatory surgery patients.
- To replace subjective nursing assessments with an objective, evidence-based tool for determining discharge readiness.
- To enhance the transition of care for pediatric patients in the perianesthesia setting.
Main Methods:
- A quality improvement (QI) project utilized the International Healthcare for Improvement's model for change.
- A multidisciplinary team including anesthesiologists and nurses implemented the pediatric readiness for discharge (P-REDI) tool.
- Interventions involved team meetings, staff education, incentives, and continuous evaluation of tool usage.
Main Results:
- Registered nurse usage of the P-REDI tool increased from 0% to a sustained 78.4% over five months.
- Discussions regarding the P-REDI tool occurred in 83% of monthly staff meetings.
- Average length of stay from door to discharge and Phase II length of stay remained consistent.
Conclusions:
- The QI project successfully promoted staff engagement with a safe discharge scoring tool in the perianesthesia environment.
- Implementing standardized Phase I and Phase II discharge scoring tools can improve safety and efficiency in perianesthesia care.
- Wider integration of such tools can lead to evidence-based practices and smoother patient transitions home globally.
Purpose:
The American Society of PeriAnesthesia Nurses supports the use of discharge scoring tools that include essential elements of clinical nursing assessments, which are necessary for the safe transition of postanesthesia patients from one level of care to the next. At a freestanding pediatric hospital in the Midwest, the absence of a standardized scoring tool to determine a pediatric patient's readiness for discharge home after ambulatory surgery in Phase II was identified. This study aimed to implement a standardized discharge scoring tool to ensure safe, consistent, and efficient patient care.
Design:
Quality improvement (QI) methodology was used for this project from July 2023 to December 2023 using the International Healthcare for Improvement's model for change.
Methods:
The multidisciplinary QI team consisted of anesthesiologists, nurses, and unlicensed personnel. The aim was to implement an already developed Phase II discharge scoring tool to replace the current nursing process, which relied on subjective assessments of the patient's readiness for discharge. The pediatric readiness for discharge (P-REDI) tool was selected based on its real-time functionality, objectivity, and evidence-based research foundation. Interventions included team meetings, multidisciplinary education, incentives, and continuous evaluation.
Findings:
The primary measure was the percentage of Phase II registered nurse (RN) usage of the P-REDI tool, which increased from a baseline of 0% to 78.4% and was sustained throughout the 5-month period. The total number of discussions about the P-REDI tool at monthly staff meetings was 83%. Additionally, the average length of stay from door to discharge remained consistent, with an average of 254.6 minutes. The Phase II length of stay also remained consistent at an average of 52.3 minutes, from the P-REDI paper implementation to P-REDI electronic health record implementation.
Conclusions:
This QI project successfully engaged staff in understanding the importance of using a safe discharge scoring tool in the perianesthesia environment. The integration of Phase I and Phase II discharge scoring tools in adult and pediatric perianesthesia departments worldwide can lead to safer, evidence-based care and smoother transitions to home.
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