A Quality Improvement Project to Increase Discharges before Noon at a Pediatric Hospital

Delays in patient discharges lead to inefficient hospital throughput and reduced access to care. The aim of this quality improvement (QI) project was to increase the percentage of discharge orders placed before noon (DOBN) by the pediatric hospital medicine (PHM) service from 27% to 32% between January 1, 2021, and December 31, 2022.

We convened a multidisciplinary team of hospitalists, residents, nurses, and bed management staff and surveyed key stakeholders to identify the most important barriers. Key interventions included the implementation of a multidisciplinary huddle, earlier preparation of the electronic health record for discharges, and prioritizing rounding on discharge-ready patients. The outcome measure was the monthly percentage of DOBN. Balancing measures were 7-day readmission rates and average length of stay (LOS). The primary measure was analyzed using a statistical process control chart (p-chart), and the balancing measures were analyzed using run charts.

The baseline rate of DOBN on the PHM service was 27%. After interventions, this increased to 32%. The LOS was 2.5 days, and the average 7-day readmission rate was 2.4%. Run chart analysis showed no special cause variation in the balancing measures. These results were sustained for 16 months without increasing LOS or 7-day readmission rates.

The QI team successfully increased the DOBN rate for a PHM service by applying QI methods and adopting a multidisciplinary approach to discharge planning and preparation.