Improving the Timeliness and Efficiency of Discharge From the NICU

Abstract

BACKGROUND Discharge from the NICU is a highly complex process. Multidisciplinary survey results and chart audits identified gaps in the timeliness and efficiency of discharge in our NICU. Using the define-measure-analyze-improve-control quality improvement framework, we aimed to increase the percentage of patients discharged before 11:00 am from a baseline mean of 9.4% to 50% without adversely impacting caregiver readiness to discharge. METHODS We used a fishbone diagram to identify causes of late and inefficient NICU discharge. A Pareto chart and Impact-Effort matrix were used to select targets for improvement efforts. Plan-do-study-act (PDSA) cycles established a goal unit discharge time, created a discharge checklist, prioritized rounding on discharging patients, set expectations for caregiver education completion, and increased nurse knowledge and comfort with providing caregiver education. RESULTS The mean percent of patients discharged before 11:00 am increased from 9.4% to 52.4%, exceeding our aim. Median discharge time improved from 13:30 pm to 11:15 am (P < .001). Discharge was more efficient as demonstrated by significantly earlier completion of many discharge tasks. These improvements did not adversely impact reported caregiver readiness to discharge (75% vs 77%, P = .76). CONCLUSIONS Quality improvement methods can significantly improve the timeliness and efficiency of NICU discharge. Improvement in this complex process may be facilitated by a multidisciplinary team that offers diverse perspectives, unique process and methodologic knowledge, and the ability to appeal to all unit stakeholders. Lessons learned from this project may benefit other teams working to improve their ICU discharge process.