A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

Abstract

OBJECTIVE: To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. METHODS: This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children’s hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan–do–study–act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. RESULTS: Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). CONCLUSIONS: Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non–children’s hospital settings.

Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge

“…Telephone calls identify postdischarge issues after pediatric hospitalization. 7 However, in children hospitalized with asthma, a postdischarge telephone call coupled with enhanced education increased reutilization rates in one study 8 but decreased them in another. 9 Despite the lack of evidence regarding the effectiveness of a postdischarge telephone call in reducing reutilization rates, telephone calls have been adopted by a large readmission reduction collaborative to prevent reutilization.…”

Hospital-to-Home Interventions, Use, and Satisfaction: A Meta-analysis

“…43,48,53,64,78,80,87,94 Similarly, FEIs were associated with improved satisfaction in children with chronic illnesses (n = 9), † † neonates (n = 3), 72,75,78 and general pediatric patients in the hospital (n = 4). 86,90,92,94 Effective FEIs included parental education (n = 13), ‡ ‡ written care plans for home (n = 1), 43 and cognitive behavioral therapy for parents (n = 1). 62…”

“…43,86 CCIs were also associated with improved satisfaction across patient populations, including effective studies in children with chronic illnesses (n = 7), 43,44,48,49,52,53,64 patients in the NICU (n = 2), 78,80 and the general hospitalized population (n = 4). 86,87,89,94 CCIs that were associated with improved satisfaction included assistance with scheduling follow-up care, 43,53,89 in-home visits or follow-up telephone calls, 44,48,49,53,64,86,94 and intensive discharge planning. 43,48,53,64,78,80,87,94 Similarly, FEIs were associated with improved satisfaction in children with chronic illnesses (n = 9), † † neonates (n = 3), 72,75,78 and general pediatric patients in the hospital (n = 4).…”

“…86,87,89,94 CCIs that were associated with improved satisfaction included assistance with scheduling follow-up care, 43,53,89 in-home visits or follow-up telephone calls, 44,48,49,53,64,86,94 and intensive discharge planning. 43,48,53,64,78,80,87,94 Similarly, FEIs were associated with improved satisfaction in children with chronic illnesses (n = 9), † † neonates (n = 3), 72,75,78 and general pediatric patients in the hospital (n = 4). 86,90,92,94 Effective FEIs included parental education (n = 13), ‡ ‡ written care plans for home (n = 1), 43 and cognitive behavioral therapy for parents (n = 1).…”

Pediatric Patient-Centered Transitions From Hospital to Home: Improving the Discharge Medication Process

“…Several pediatric collaboratives have formed to study and improve safety during this critical handoff. [1][2][3] Discharge medications are a key component to safe hospital discharge. Challenges with medication access and caregiver understanding of administration instructions can lead to medication errors, hospital readmissions, and poor outcomes.…”