Background: Inpatient hospital care cost $971.8 billion in 2014 and costs are projected to rise by 5.8% per year. Inpatient operational efficiency and waste reduction have become the focus of cost-reduction measures. A recent study found that nearly one in four patients in a pediatric hospital experienced a medically unnecessary prolonged length of stay with a mean delay of 2.1 days. Improving discharge timeliness and efficiency can reduce costs, increase hospital capacity, enhance patient flow, and improve patient satisfaction.
Methods: Using quality improvement methodology, we analyzed key drivers of discharge delays on a Pediatric Gastroenterology inpatient service and implemented interventions to improve discharge timeliness. Interventions included restructuring of daily rounds to prioritize discharge-ready patients, standardizing team-based family-centered rounding such as walk rounds in patient rooms with families and nurses, and implementing medical and logistical discharge criteria into the electronic medical record workflow for the most common diagnoses of constipation, Crohn’s disease, pancreatitis, and ulcerative colitis. Process measures included discharge order time, discharge time of day, and discharge response time; length of stay (LOS) overage was used as a balancing measure.
Results: For June to August 2016, median discharge order time improved compared to the same period in 2015, from 12:40pm to 12:10pm. Discharge time of day was delayed from a median of 2:13pm to 2:25pm, and discharge response time similarly increased from 53 minutes to 70 minutes. LOS overage improved, demonstrating a reduction of 9 hours.
Conclusions: These data indicate that compared to baseline our interventions resulted in earlier discharge orders placed in the EMR and decreased LOS, even if discharges occurred later in the day. However, these results are preliminary given the sample size of 50 discharges, and data will continue to be monitored through December 2016.