Using quality improvement to optimise paediatric discharge efficiency

White, Christine M.; Statile, Angela; White, Denise L.; Elkeeb, Dena; Tucker, Karen; Herzog, Diane E.; Warrick, Stephen; Warrick, Denise; Hausfeld, Julie; Schondelmeyer, Amanda C.; Schoettker, Pamela J.; Kiessling, Pamela; Farrell, Michael; Kotagal, Uma R.; Ryckman, Frederick C.

doi:10.1136/bmjqs-2013-002556

Cited by 77 publications

(76 citation statements)

References 16 publications

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“…Although other US hospitals have attempted to ensure medication possession at discharge, 5 descriptions of mechanisms that successfully achieve this goal are lacking.…”

Section: Discussionmentioning

confidence: 99%

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Increasing Medication Possession at Discharge for Patients With Asthma: The Meds-in-Hand Project

et al. 2016

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Asthma is the second most costly chronic disease in children. 1 Emergency department (ED) visits, admissions, and readmissions account for the most expensive components of care. Ensuring patient possession of medications at discharge from hospitalization is a recognized strategy to reduce unplanned presentations to care. [2][3][4] Although medication possession does not guarantee adherence to a treatment plan, it eliminates the posthospitalization burden of going to a pharmacy, makes certain families have cleared all insurance barriers, and allows medicationrelated questions to be answered with the product in hand. However, routine disbursement of outpatient medications before discharge is not standard care for most pediatric abstract BACKGROUND AND OBJECTIVES: Many patients recently discharged from an asthma admission do not fill discharge prescriptions. If unable to adhere to a discharge plan, patients with asthma are at risk for re-presentation to care. We sought to increase the proportion of patients discharged from an asthma admission in possession of their medications (meds in hand) from a baseline of 0% to >75%.

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“…Although other US hospitals have attempted to ensure medication possession at discharge, 5 descriptions of mechanisms that successfully achieve this goal are lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Though uncommon, delivering outpatient medications to patients before discharge is not novel and has been used in concert with other interventions. 5 However, to our knowledge this report is the first to detail specific strategies to reliably discharge patients with meds in hand.…”

Section: Discussionmentioning

confidence: 99%

Increasing Medication Possession at Discharge for Patients With Asthma: The Meds-in-Hand Project

et al. 2016

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“…Previous process improvement on acute care patients 7 included identification of medical goals for discharge and real-time documentation of when goals were met by bedside RNs via an EHR timestamp ( Fig 1); the same process was applied to complex patients. We created a multidisciplinary group that included HM attending physicians, RNs, care managers, pharmacists, pediatric residents, social workers, and parents of children with medical complexity.…”

Section: Planning the Interventionmentioning

confidence: 99%

“…We focused on these 2 units becuase they already followed the discharge process based on medical goals from our previous work. 7 Median length of stay (LOS) was a secondary outcome measure. To ensure that our work in expediting discharge did not negatively impact readmission, 30-day readmission rate was evaluated as a balancing measure.…”

Section: Figurementioning

confidence: 99%

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Improving Discharge Efficiency in Medically Complex Pediatric Patients

et al. 2016

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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.

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

et al. 2018

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Hospital-to-Home Outcomes Trial Study Group IMPORTANCE Families often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services.OBJECTIVE To determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. DESIGN, SETTING, AND PARTICIPANTSThis Hospital-to-Home Outcomes (H2O) randomized clinical trial included 966 children and adolescents younger than 18 years (hereinafter referred to as children) admitted to general medicine services at a free-standing tertiary care children's hospital from May 11 through October 31, 2016. Data were analyzed as intention to treat and per protocol.INTERVENTIONS A postdischarge telephone call within 4 days of discharge compared with standard discharge. MAIN OUTCOMES AND MEASURESThe primary outcome was the 30-day reutilization rate for urgent health care services (ie, unplanned readmission, emergency department visit, or urgent care visit). Secondary outcomes included additional utilization measures, as well as parent coping, return to normalcy, and understanding of clinical warning signs measured at 14 days.RESULTS A total of 966 children were enrolled and randomized (52.3% boys; median age [interquartile range], 2.4 years [0.5-7.8 years]). Of 483 children randomized to the intervention, the nurse telephone call was completed for 442 (91.5%). Children in the intervention and control arms had similar reutilization rates for 30-day urgent health care services (intervention group, 77 [15.9%]; control group, 63 [13.1%]; P = .21). Parents of children in the intervention group recalled more clinical warning signs at 14 days (mean, 1.8 [95% CI, 1.7-2.0] in the intervention group; 1.5 [95% CI, 1.4-1.6] in the control group; ratio of intervention to control, 1.2 [95% CI, 1.1-1.3]).CONCLUSIONS AND RELEVANCE Although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, this method shows promise to bolster postdischarge education.

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Using quality improvement to optimise paediatric discharge efficiency

Abstract: Through standardising discharge goals and implementation of high-reliability interventions, we reduced LOS without increasing readmission rates.

Cited by 77 publications

References 16 publications

Increasing Medication Possession at Discharge for Patients With Asthma: The Meds-in-Hand Project

Increasing Medication Possession at Discharge for Patients With Asthma: The Meds-in-Hand Project

Improving Discharge Efficiency in Medically Complex Pediatric Patients

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

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