200 - QI Initiative to Improve Discharge Efficiency of the Medically Complex Child from the PICU

Poster Number: 200

Jessica E. Allen, Nemours Children's Hospital, Oviedo, FL, United States; Jennifer L. Liedel, Nemours Children's Hospital, Orlando, FL, United States; Thomas Pott, Nemours Childrens Health, Orlando, FL, United States; Tiffany S. Gwartney, University of South Florida, Tampa, FL, United States

Background: Discharging children with complex medical needs, including home nursing and durable medical equipment, is a labor-intensive, time-consuming task. Without a clear process guiding the complex discharge, there are many opportunities for discharge delays resulting in additional days in hospital after a patient could be released, and there is a potential for an increased number of unplanned readmissions. There are few reports in the literature that directly address this issue for PICU patients.

Objective: The purpose of the initiative was to create a standardized DC process for MCPs admitted to the PICU. The initiative aims included determining how improving discharge efficiency among medically complex patients affected overstay days, cost, and 30-day unplanned readmissions.

Design/Methods: After obtaining IRB exemption, a QI initiative was undertaken to determine the impact of a multidisciplinary process map for health care providers and families on overstay days, cost, and unplanned readmissions. This process map was designed to create a shared mental model of the progress each child and family made toward the goal of discharge. Technology dependent children admitted to the PICU in a freestanding children’s hospital between May-July 2021 were included. Monthly plan-do-study-act cycles were utilized to assess effect of the interventions.

Results: There were 35 patients who qualified for this discharge planning intervention. Overstay days were determined by adjusted DRG codes. Overstays decreased by a factor of 3, from 5.6 to 1.7 days. Corresponding cost savings for reduction in overstay was approximately $45,000 per patient. An additional benefit of the QI initiative is the value of resource allocation and bed space availability associated with the decrease in overstays. The percentage of children with unplanned 30-day readmissions was decreased by more than 50%, decreasing from 6.6% to 2.6%. This readmission rate excluded children admitted for planned procedural eventsConclusion(s): Overall, the development of the discharge process for the medically complex child in the PICU led to a clinically significant improvement in overstay days and hospital costs, with no negative consequence in unplanned 30-day readmissions. Sustainability of the QI project will be determined with ongoing evaluation. Given the success of the QI project, the discharge process map is being considered for utilization in other ICUs throughout the hospital.