Improving Discharge Efficiency in Medically Complex Pediatric Patients

Abstract

BACKGROUND AND OBJECTIVE: Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%. METHODS: We used quality improvement methods to identify key drivers and inform interventions. Medical discharge goals were defined on admission for each patient. Interventions included implementation of a complex care inpatient team with electronic admission order set, weekly care coordination rounds, needs assessment tool, and medication pathway. The primary measure, percentage of patients discharged within 2 hours of meeting medical discharge goals, was followed on a run chart. The secondary measures, pre- and post-intervention length of stay and 30-day readmission rate, were compared by using Wilcoxon rank-sum and χ2 tests, respectively. RESULTS: The percentage of medically complex patients discharged within 2 hours of meeting medical discharge goals improved from 50% to 88% over 17 months and sustained for 6 months. In preintervention–postintervention comparison, median length of stay did not change (3.1 days [interquartile range, 1.8–7.0] vs 2.9 days [interquartile range, 1.7–6.1]; P = .67) and 30-day readmission rate was not impacted (30.7% vs 26.4%; P = .51). CONCLUSIONS: Efficient discharge for medically complex patients requires support of a multidisciplinary team to proactively address discharge needs, ensuring patients are ready for discharge when medical goals are met.

Impact of hospital transfer on surgical outcomes of intestinal atresia

“…Our study can contribute to the current knowledge on regionalization of pediatric care by highlighting this prolonged LOS period for transferred patients, prompting physicians to make changes in managing these patients. Patients may need early identification of discharge needs on admission, which is discussed in research by Statile et al as a crucial element to ensure timely discharge of patients (10). By setting discharge goals on admission, a physician can enlist all members of the care team to help meet this goal and prevent delayed LOS and associated medical costs.…”

Key constituents for integration of care for children assisted with long-term home ventilation: a European study

“…Policies or procedures in place to support quality assurance for service providers 57.7 (15) Data collected on the experience of care from the perspective of the parents/guardians 30.7 (8) Data collected on the experience of care from the perspective of the siblings 11.5 (3) to home', 'coordinated pathway to specialist care' and 'legal and governance structures'.…”

“…There is an increasing focus on the management of care of children with complex care needs (CCNs), defined as multidimensional health and social care needs, in the presence of a recognised medical condition or where there is no unifying diagnosis [1]. The provision of care closer to home has been identified internationally as an important objective for this population [2,3]. This supports a child-centric approach to care within a health service that is increasingly focused on enhancing integrated care delivery.…”

Development of a New Care Model for Hospitalized Children With Medical Complexity

“…During care coordination rounds, the team reviews each patient' s discharge goals, outlining tasks to be completed before discharge. 12 To facilitate this discussion, discharge goals are listed and updated in the electronic health record. 13 Additionally, a needs assessment tool was designed to guide 8 key aspects of discharge planning: home health care visits, durable medical equipment, medications, follow-up, private duty nursing, family concerns, family education (eg, on medical technology), and transportation.…”

“…13 Additionally, a needs assessment tool was designed to guide 8 key aspects of discharge planning: home health care visits, durable medical equipment, medications, follow-up, private duty nursing, family concerns, family education (eg, on medical technology), and transportation. 12 The completion of the needs assessment tool begins on admission and is reviewed regularly with care managers throughout the patient' s hospitalization to facilitate completion of tasks before discharge.…”