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OBJECTIVES: To reduce 7-day acute care reuse among children with asthma after discharge from an academic children’s hospital by standardizing the delivery of clinical care and patient education. METHODS: A diverse group of stakeholders from our tertiary care children’s hospital and local community agencies used quality improvement methods to implement a series of interventions within inpatient, emergency department (ED), and outpatient settings. These interventions were designed to improve admission, inpatient care, and discharge processes for children hospitalized because of asthma and included a focus on (1) resident education, (2) patient access to medication and asthma education, and (3) gaps in existing asthma clinical care pathways in the ED and ICU. The primary outcome was the rate of 7-day acute care reuse (combined hospital readmissions and ED revisits) after discharge from an index hospitalization for asthma, measured through a monthly review of electronic health record data and compared with a 6-month baseline period of reuse data. RESULTS: The mean 7-day reuse rate for asthma after discharge was 3.7% during the 6 months baseline period (n = 107) and 1.0% during the 15-month intervention period (n = 302). This included a shift in our median from 3.3% to 0% with an 8-month period of no 7-day reuse. CONCLUSIONS: An interprofessional quality improvement team successfully achieved and sustained a 73% reduction in mean 7-day asthma-related acute care reuse after discharge by standardizing provider training, care processes, and patient education.

Background: Inpatient surgical teams are challenged with treating complex patients, communicating across disciplines, educating trainees, and transitioning between the operating room, clinic, and inpatient unit. Systematic approaches to rounds are needed to perform these tasks effectively. Prior studies on nonsurgical units have shown that rounding checklists improve patient safety and trainee education. However, few studies have investigated the utility of checklists on surgical rounds.Objective: The purpose of this article is to synthesize the evidence regarding rounding checklists on inpatient surgical units, with a focus on structure, content, utilization, outcomes, and educational value.Methods: A narrative review was completed after a search of PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature in November 2020 using the following index terms and keywords: pediatrics, operative surgical procedures, surgery, perioperative period, teaching rounds, rounds, checklist, rounding tool, and rounding list. Results:We identified 11 relevant studies. Six were conducted on inpatient surgical units (54%), and five were conducted on medicine or critical care units (46%). The structure and content of checklists were varied, with most integrating subjective and objective findings. These studies show that rounding checklists improve the organization and completeness of rounds, interdisciplinary communication, documentation, adverse event rates, and educational opportunities. However, they also increase rounding time and require reinforcement for sustained compliance. Conclusions:The existing literature suggests rounding checklists can help create a culture of safety in which every team member, from nurse to attending, actively participates in improving patient care. We provide strategies to develop rounding checklists for pediatric surgical units.