Gargi Mukherjee, Emory University School of Medicine, Atlanta, GA, United States; Whitney Sherry, Emory University School of Medicine, Atlanta, GA, United States
Assistant Professor of Pediatrics Emory University School of Medicine ATLANTA, Georgia, United States
Background: As families returned to work/school following the COVID-19 pandemic, our institution, like many others, faced high patient volumes and increased boarding in the Emergency Department. This quality improvement project aimed to streamline discharge processes by implementing a daily multidisciplinary discharge huddle to enhance awareness of discharge needs. Objective: The primary objective was to increase the percentage of pediatric hospital medicine patients discharged by noon by 15% over 12 months. The secondary objective was to reduce the time from discharge order to discharge completion. The process measure focused on improving communication and awareness of discharge needs amongst the multidisciplinary team. Length of stay (LOS) was chosen as our balancing measure. Design/Methods: This single-center quality improvement project was conducted within a pediatric hospital medicine service at a tertiary care center where patients are admitted across multiple floors. Nurses, case managers, and social workers were floor-based, while physicians and pharmacists were not. Multidisciplinary huddles were created to address key drivers of discharge delays, including medication authorizations, patient education, durable medical equipment arrangements, and discharge criteria. The huddles, initially implemented on one floor, were expanded to three floors and included nurses, physicians, case managers, social workers, pharmacists, and child life specialists. Additional interventions involved changing the time of meeting, developing standardized scripts, and creating shared documentation within Epic. Statistical process control charts tracked the percentage of patients discharged by noon, discharge completion time, and LOS. Surveys were administered at two intervals to evaluate participant feedback on communication and proactive identification of discharge needs. Results: No significant variation was seen in discharges by noon (mean: 13.7%) nor LOS (mean: 2.5 days). The time from discharge order to discharge completion was reduced by 10 minutes, but this change was not sustained. Two surveys were conducted, with 14 and 42 participants, respectively. In both surveys, over two-thirds of participants agreed or strongly agreed that the huddles improved proactive identification of patient needs and enhanced communication among team members.
Conclusion(s): Although the project did not result in an increase in discharges by noon, it successfully fostered proactive discharge planning and improved communication within the multidisciplinary team. The huddles have remained in place for over 2 years and are continuously improving.
Figure 2. Statistical process control charts PAS Fig 2 Process Control.pdfA. Percent discharges by noon, B. Average Time from Discharge Order to Discharge, and C. Length of Stay of patients on the pediatric hospital medicine team.
