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A New Dawn: Improving Early Discharge Times and Family Experience With "Sunrise Discharges" at a Tertiary Paediatric
Daniel Dorevitch1, Christine Kwa1, Simon Craig2
1Department of General Paediatrics, Monash Children's Hospital, Melbourne, Australia.
Insights
Early-morning discharges for pediatric patients ("Sunrise Discharges") significantly increased early departures and improved family satisfaction. This initiative did not overburden night staff, showing potential for wider adoption.
Area of Science:
- Pediatric healthcare management
- Hospital operations and efficiency
- Patient flow optimization
Background:
- Pediatric medical discharges often face delays due to daytime ward rounds, impacting hospital capacity and patient experience.
- Current discharge processes can lead to prolonged hospital stays for children awaiting routine procedures.
- Inefficient discharge timing contributes to decreased patient and family satisfaction.
Purpose of the Study:
- To evaluate the effectiveness of an early-morning discharge program on timing of pediatric discharges.
- To assess the impact of the initiative on family satisfaction levels.
- To understand the effect on night medical staff workload and experience.
Main Methods:
- Implementation of a "Sunrise Discharges" project in a tertiary children's hospital, discharging eligible patients before morning handover.
- A 3-month pilot in the General Paediatric department with continuous staff communication and feedback mechanisms.
- Utilized "Plan, Do, Study, Act" cycles for quality improvement, incorporating staff/parent surveys and chart reviews.
Main Results:
- Achieved a nearly seven-fold increase in pediatric discharges before 9:00 a.m. (0.65% to 4.46%).
- Received positive feedback from parents regarding the discharge process.
- Night staff reported no unmanageable increase in workload, with their feedback aiding process refinement.
Conclusions:
- The Sunrise Discharge project successfully improved discharge timing and family experience in pediatric care.
- The initiative demonstrates potential for scalability to other departments and pediatric centers.
- Further refinements can optimize the process for broader hospital-wide implementation.
Background:
Paediatric patients requiring a medical discharge generally have to wait for daytime ward rounds before leaving hospital. This can lead to unnecessary discharge delays spanning hours, with impacts on hospital capacity and patient satisfaction.
Aims:
To assess the impact of an early-morning discharge project on discharge by time of day, family satisfaction, and staff experience.
Methods:
A novel approach ("Sunrise Discharges") was trialled and audited at a tertiary children's hospital, whereby appropriate patients were discharged by night medical staff prior to morning handover. The Sunrise Discharge project was piloted in the General Paediatric department for 3 months starting from 1 August 2024, with prior communication to clinical staff through multiple channels. Analysis of patient discharge time trends was performed to assess the impact of this initiative. In addition, "Plan, Do, Study, Act" quality improvement cycles were implemented throughout the 3-month audit period utilising feedback from staff surveys, a parent experience survey, and chart reviews to improve this process.
Results:
The implementation of Sunrise Discharges resulted in a nearly seven-fold increase in the percentage of total general paediatric discharges prior to 09:00 a.m. (0.65%-4.46%, p < 0.0001) when compared to the 3 months prior. Parent feedback on the project was positive. Staff provided helpful feedback which guided project improvement and notably, night staff did not feel this added unmanageable workload to their shifts.
Conclusion:
The Sunrise Discharge project significantly improved discharge by time of day, with positive family experience of the process. With further refinement, it holds potential for hospital-wide implementation and broader use in other paediatric centres.
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