Impact of a Quality Improvement Initiative to Optimize the Discharge Process of Pediatric Gastroenterology Patients at an Academic Children’s Hospital

Abstract

Introduction:Discharge is an important and complex process that can be optimized to reduce inpatient healthcare inefficiency and waste. This study aimed to increase the percentage of patients discharged before 1 pm by 20% from an academic inpatient pediatric gastroenterology service (IPGS), over 6 months.Methods:We conducted a preintervention and postintervention study of patients discharged from IPGS. Patients discharged from January to June 2016, and those following our intervention from June to December 2016, were studied. Interventions included (1) implementation of the electronic medical record medical and logistical discharge criteria checklists for the 4 most common IPGS discharge diagnoses, (2) standardization of the rounds process to prioritize discharge, (3) education of nursing staff and families about the role they played in discharge. Process, outcome, and balancing measures were analyzed.Results:Three hundred fifty-five total discharges were studied. Between the preintervention and postintervention groups, there were no significant improvements in discharge order time, physical discharge time, discharge response time, or discharges before 1 pm. The balancing measure of 30-day readmission was unaffected. However, length of stay (LOS) index, calculated as the ratio of actual to expected LOS, improved; when translated into days, LOS declined by 1 day, with potential associated savings of $373,000.Conclusions:Interventions to improve discharge timeliness on IPGS service demonstrated mixed effectiveness. Only LOS index improved. Further iterative quality improvement interventions are needed to continue optimizing discharge timeliness and change the culture of pediatric discharge on inpatient subspecialty services in academic children’s hospitals.

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

“…The outcome on-time starts (OTS), was measured in seven studies, all of them with positive results. For discharge order time, eight studies reported an earlier discharge time, while one study reported no change [ 93 ]. Table 1 shows the direction of the findings for the main outcomes.…”

“…Interesting, when the main goal is to reduce infections within surgical units, LH contributed to reducing the LOS in two out of three studies [ 18 , 100 ], while one study [ 86 ] reported no change. Moreover, when LOS was reduced, other associated benefits were reported, such as cost reductions [ 17 , 95 , 99 , 100 ], a better return of investment [ 48 ], increased savings [ 47 , 90 , 93 , 98 , 102 ], or an earlier discharge order [ 3 , 19 ].…”

“…Operating rooms are linked to significant costs in most hospitals [ 147 ] but are potentially the most lucrative part of many healthcare systems [ 103 ]. With surgical care representing about a third of all healthcare spending [ 148 ], and with healthcare costs continuing to rise [ 149 , 150 ], healthcare enterprises are focusing on eliminating inpatient operational inefficiencies and waste to reduce unnecessary costs [ 93 ]. Thus, the OR represents an area with an opportunity to optimize work flow and supply use [ 151 ], and to maintaining an economically viable institution [ 22 ].…”

“…Hereafter, a brief follow-up analysis might not be an appropriate indicator of improvement. Some other characteristics that might compromise the sustainability of LH achievements include increased patient volume [ 138 ], a poor understanding of the organizational context [ 169 ], insufficient space and time for coherent team co-operative improvement, the tension between promoting staff ownership and providing direction [ 88 ], the incomplete or slow adoption of the interventions [ 93 ], and a lack of standardization [ 48 ]. Naturally, to fully realize the potential benefits of LH, organizations need to minimize the impact of such barriers and capitalize on facilitating conditions that are specific to their local contexts [ 134 ].…”

The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study

“…Typical workflows rely on processes implemented outside of the electronic health record (EHR), such as meetings, paging, and telephone calls, which are inadequate for efficient discharge communication and frequently interrupt patient care [ 25 , 26 ]. Health information technology solutions most often described in the literature include passive communication tools, such as electronic patient journey boards, hospital capacity dashboards, asynchronous electronic reports, and discharge checklists [ 4 , 27 - 34 ], or health information technology tools that reside outside of the EHR [ 35 , 36 ]. Even commonly used tools within the EHR, such as messaging or conditional discharge orders, do not provide real time, integrated communications despite being a function of an EHR [ 37 , 38 ].…”