Affiliation:
1. Medical College of Wisconsin, Wauwatosa, Wisconsin
2. Children’s Wisconsin, Wauwatosa, Wisconsin
3. Washington University, St. Louis, Missouri
Abstract
OBJECTIVE
Clear communication about discharge criteria with families and the interprofessional team is essential for efficient transitions of care. Our aim was to increase the percentage of pediatric hospital medicine patient- and family-centered rounds (PFCR) that included discharge criteria discussion from a baseline mean of 32% to 75% over 1 year.
METHODS
We used the Model for Improvement to conduct a quality improvement initiative at a tertiary pediatric academic medical center. Interventions tested included (1) rationale sharing, (2) PFCR checklist modification, (3) electronic discharge SmartForms, (4) data audit and feedback and (5) discharge criteria standardization. The outcome measure was the percentage of observed PFCR with discharge criteria discussed. Process measure was the percentage of PHM patients with criteria documented. Balancing measures were rounds length, length of stay, and readmission rates. Statistical process control charts assessed the impact of interventions.
RESULTS
We observed 700 PFCR (68 baseline PFCR from July to August 2019 and 632 intervention period PFCR from November 2019 to June 2021). At baseline, discharge was discussed during 32% of PFCR. After rationale sharing, checklist modification, and criteria standardization, this increased to 90%, indicating special cause variation. The improvement has been sustained for 10 months.
At baseline, there was no centralized location to document discharge criteria. After development of the SmartForm, 21% of patients had criteria documented. After criteria standardization for common diagnoses, this increased to 71%. Rounds length, length of stay, and readmission rates remained unchanged.
CONCLUSION
Using quality improvement methodology, we successfully increased verbal discussions of discharge criteria during PFCR without prolonging rounds length.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health
Reference24 articles.
1. Postdischarge adverse events in children: a cause for concern;Tsilimingras;Jt Comm J Qual Patient Saf,2009
2. Adverse events among medical patients after discharge from hospital;Forster;CMAJ,2004
3. The incidence and severity of adverse events affecting patients after discharge from the hospital;Forster;Ann Intern Med,2003
4. Discharge planning from hospital to home;Shepperd;Cochrane Database Syst Rev,2013
5. Effects of implementing a health team communication redesign on hospital readmissions within 30 days;Opper;World views Evid Based Nurs,2019
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