Resident Physician Golisano Children's Hospital at the University of Rochester University of Rochester Medical Center Rochester, New York, United States
Background: Communication related to discharge planning can be highly variable, resulting in confusion among families and members of the care team. To facilitate timely and safe discharge, early communication within the inpatient care team and with patients and families is essential. With a shared understanding, the care team and families can anticipate discharge needs and goals.
Objective: The SMART aim was to increase the documentation of discharge goals for patients admitted to the Pediatric Hospital Medicine (PHM) service on one unit from 0% to 50% within 6 months. A secondary aim was to reduce the average length of stay (LOS) of PHM patients discharged from our study unit by 5%.
Design/Methods: A multidisciplinary team of providers, nurses, care coordinators, and a pharmacist was convened. Baseline data collection and project planning occurred from Jan-May 2019. PDSA cycles began in June 2019 and included: (1) creation of a standardized discharge goals smart phrase, (2) distribution of and education on the discharge goals smart phrase, (3) auditing and feedback of discharge goal documentation, (4) standardization of care coordination rounds, and (5) discussion of discharge goals during family-centered rounds. Weekly chart reviews of randomly sampled progress notes monitored the use of the discharge goals smart phrase; results were tracked via run charts. Average LOS included time on other units. 7-day readmission rate was our balancing measure; study unit rates were compared to hospital-wide rates and analyzed via chi-square.
Results: Early in our intervention period, discharge goals documentation improved from a pre-intervention baseline of 0% to a median of 55%. By October 2019, we observed a shift in the median as the discharge goal documentation rate increased to 91% (Figure 1). Our study unit temporarily closed due to COVID-19 (April-May 2020), but results have since been sustained. Average LOS did not meet our 5% reduction goal. We did, however, see a 42% reduction in 7-day readmission rates from 4.8% to 2.8% within the study unit (Figure 2). Conclusion(s): Guided by our multidisciplinary team, a series of PDSA cycles led to significant improvement in discharge goals documentation. We did not meet our LOS reduction goal but did observe a decrease in 7-day readmission rates. Standardized documentation and discussion of discharge goals may lead to improved communication and discharge preparedness.
Figure 1: Run Chart Illustrating Documentation of Discharge Goals (SMART Aim)
Figure 2: 12 Month 7-Day Readmission Rate
Authors/Institutions: Karina Vattana, University of Rochester Medical Center, Rochester, New York, United States; Joshua Noel, University of Rochester Medical Center, Rochester, New York, United States; Meredith Bennett, University of Rochester Medical Center, Rochester, New York, United States; Christine Echtenkamp, University of Rochester Medical Center, Rochester, New York, United States; Anne A. Fallon, University of Rochester Medical Center, Rochester, New York, United States; Kate G. Ostrander, University of Rochester Medical Center, Rochester, New York, United States; Jan Schriefer, University of Rochester Medical Center, Rochester, New York, United States; Lauren G. Solan, University of Rochester Medical Center, Rochester, New York, United States
