Improving Discharge Efficiency in Medically Complex Pediatric Patients
| Autor: | Denise L. White, Angela M. Statile, Christine M. White, Julie Hausfeld, Joanna Thomson, Laura H Brower, Blair Davis, Karen Tucker, Jacob Redel, Amanda C. Schondelmeyer |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Quality management Adolescent MEDLINE Psychological intervention Run chart Patient Readmission Patient Care Planning 03 medical and health sciences 0302 clinical medicine Interquartile range 030225 pediatrics Humans Medicine 030212 general & internal medicine Child Patient Care Team business.industry Infant Newborn Infant Length of Stay Hospitals Pediatric medicine.disease Home Care Services Quality Improvement Patient Discharge Hospital medicine Child Preschool Pediatrics Perinatology and Child Health Needs assessment Female Medical emergency business Goals Needs Assessment Order set |
| Zdroj: | Pediatrics. 138 |
| ISSN: | 1098-4275 0031-4005 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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