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Pediatrics. 2016 Aug;138(2). pii: e20143604. doi: 10.1542/peds.2014-3604.

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.

Author information

1
Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California; suwu@chla.usc.edu.
2
Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado; Children's Hospital Colorado, Aurora, Colorado;
3
Children's Hospital Association, Overland Park, Kansas;
4
Department of Surgery, Division of Urology, University of California San Diego, San Diego, California; Rady Children's Hospital San Diego, San Diego, California;
5
Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California;
6
Children's Hospital Los Angeles, Los Angeles, California;
7
Children's Hospital Colorado, Aurora, Colorado;
8
Children's Hospital & Medical Center, Omaha, Nebraska;
9
Rady Children's Hospital San Diego, San Diego, California;
10
Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana; and.
11
Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana; and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.

Abstract

OBJECTIVE:

To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges.

METHODS:

This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies.

RESULTS:

Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05).

CONCLUSIONS:

Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings.

PMID:
27464675
DOI:
10.1542/peds.2014-3604
[Indexed for MEDLINE]
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