Faculty Collaboration Database

Using Quality Improvement Methodology to Increase Communication of Discharge Criteria on Rounds. Hosp Pediatr 2022 Feb 01;12(2):156-164

Date

01/07/2022

Pubmed ID

34988584

DOI

10.1542/hpeds.2021-006127

Scopus ID

2-s2.0-85148953017 (requires institutional sign-in at Scopus site)   6 Citations

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.

Author List

Christianson K, Kalinowski A, Bauer S, Liu Y, Titus L, Havas M, Lynch K, Rogers A

Authors

Sarah Bauer MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Amanda Rogers MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Lauren Titus MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Checklist
Child
Communication
Humans
Length of Stay
Patient Discharge
Quality Improvement
Teaching Rounds