title: Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated With Intravenous Methylprednisolone: A Quality Improvement Project.
abstract: OBJECTIVE
  Delays in patient hospital discharge affect care value through costs of prolonged length of stay and barriers to patient flow within the hospital. We sought to facilitate early-in-day discharges (EIDDs) without extending length of stay for inpatients with multiple sclerosis admitted for acute exacerbations and treated with intravenous (IV) methylprednisolone.
  
  
  METHODS
  We developed a standardized admission order set, a provider checklist, and a patient checklist to better coordinate in-hospital care and discharge planning for patients with multiple sclerosis admitted for IV methylprednisolone treatment. The order set allowed providers to enter an accelerated dosing schedule of methylprednisolone, as appropriate, to ensure administration of the final dose of methylprednisolone in the morning on the anticipated day of discharge. We compared a prospective intervention cohort to a retrospective, preintervention baseline cohort.
  
  
  RESULTS
  At baseline (N = 25), 12.0% of patients were EIDD compared to 40.7% of intervention patients (N = 27; P = .03). In all, 85.2% of intervention patients compared to 64.0% of baseline patients were discharged on the same day as last methylprednisolone treatment (P = .11). No difference was observed in median length of stay and 30-day readmission rate between groups.
  
  
  CONCLUSIONS
  Use of a standard admission order set as well as provider and patient checklists can facilitate EIDD and hospital bed availability without compromising care quality for a select group of neurology inpatients.
authors.affiliation: Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Probasco
authors.affiliation: Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Hawley
authors.affiliation: Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Margie
authors.initials: M
authors.lastname: Burnett
authors.affiliation: Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Lorrie
authors.initials: L
authors.lastname: Gibson
authors.affiliation: Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Carter
authors.affiliation: Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harlow
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Russell
authors.affiliation: Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Huffman
authors.affiliation: Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Adams
authors.affiliation: Department of Medicine and Surgery Social Work, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Terry
authors.initials: T
authors.lastname: Ziegler
authors.affiliation: Department of Quality Improvement, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Sporney
authors.affiliation: Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
authors.affiliation: Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Puttgen
keywords: multiple sclerosis; quality