Quality improvement strategies improve pediatric neurology inpatient discharges before noon

Abstract

Background: Early hospital discharge is an important quality improvement (QI) measure that has not been well studied in pediatric neurology. The objective of our study was to implement strategies to improve hospital discharge times for patients admitted to the pediatric neurology service.

Methods: This was a pilot QI study of hospital discharge before noon (DBN) in pediatric neurology patients admitted to a tertiary care children's hospital. The study duration was 6 months (12/2017-05/2018)-first 3 months preintervention and next 3 months postintervention. Strategies focusing on preidentifying MRI candidates and those needing home care services, identifying pharmacy preference, reviewing overnight video EEGs first thing in the morning, and implementing morning huddles, etc., were implemented. Demographic and clinical data were collected, including age, sex, race, and reasons for delay in discharge. Chi-square, t test, and survival analysis (log-rank test) were performed to determine differences between baseline and post-QI implementation.

Results: One hundred ninety-one patients were included in the study. There were 76 participants before the implementation of the study and 115 participants during the study. DBN percentage increased in the intervention period, from a baseline of 40.7% to 60.8%. Survival analysis showed that the discharge time after QI implementation improved significantly (p = 0.043).

Conclusions: Our study successfully identified the factors associated with late discharge and developed effective strategies to improve DBN in an inpatient pediatric neurology setting.

Figure 1. Flowchart depicting workflow of the patient from admission to discharge

Figure 2. Survival functions

Survival analysis plot comparing baseline vs during QI implementation (dark black line: baseline; light gray line: during QI implementation).