title: Improving Discharge Efficiency in Medically Complex Pediatric Patients.
abstract: Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%.
  
  
  
  We used quality improvement methods to identify key drivers and inform interventions. Medical discharge goals were defined on admission for each patient. Interventions included implementation of a complex care inpatient team with electronic admission order set, weekly care coordination rounds, needs assessment tool, and medication pathway. The primary measure, percentage of patients discharged within 2 hours of meeting medical discharge goals, was followed on a run chart. The secondary measures, pre- and post-intervention length of stay and 30-day readmission rate, were compared by using Wilcoxon rank-sum and χ(2) tests, respectively.
  
  
  
  The percentage of medically complex patients discharged within 2 hours of meeting medical discharge goals improved from 50% to 88% over 17 months and sustained for 6 months. In preintervention-postintervention comparison, median length of stay did not change (3.1 days [interquartile range, 1.8-7.0] vs 2.9 days [interquartile range, 1.7-6.1]; P = .67) and 30-day readmission rate was not impacted (30.7% vs 26.4%; P = .51).
  
  
  
  Efficient discharge for medically complex patients requires support of a multidisciplinary team to proactively address discharge needs, ensuring patients are ready for discharge when medical goals are met.
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio angela.statile@cchmc.org.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Statile
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence.
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Schondelmeyer
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Thomson
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Brower
authors.affiliation: James M. Anderson Center for Health Systems Excellence.
authors.forename: Blair
authors.initials: B
authors.lastname: Davis
authors.affiliation: Division of Endocrinology, and.
authors.forename: Jacob
authors.initials: J
authors.lastname: Redel
authors.affiliation: Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Julie
authors.initials: J
authors.lastname: Hausfeld
authors.affiliation: Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Karen
authors.initials: K
authors.lastname: Tucker
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence.
authors.forename: Denise L
authors.initials: DL
authors.lastname: White
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence.
authors.forename: Christine M
authors.initials: CM
authors.lastname: White
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006040:Goals; D006699:Home Care Services / Q000458:organization & administration; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D020380:Needs Assessment / Q000458:organization & administration; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*