Professional Documents
Culture Documents
included designing standardized with 9 postintervention points below diagnosis, at 72 hours (Fig 3A) and
discharge instructions for certain the baseline mean and the final at 30 days (Fig 3B). Four hospitals
diagnoses, making instructions more postintervention point below the reported both rates. There was no
user-friendly, and creating new lower control limit. The aggregate improvement in unplanned 72-hour
discharge instruction forms in the rate of care failures was overall 34% (0.7% vs 1.1%, P = .29) and slight
electronic medical record. Almost all in the first project quarter; the rate at worsening of the 30-day readmission
sites (9 of 10) used postdischarge the end of the collaborative was 21%, rate (4.5% vs 6.3%, P = .05).
follow-up phone calls to reinforce or a reduction of 40% (P < .05). Top-
Of the 11 participating sites, 4
discharge instructions. Most sites also performing hospitals were able to
achieved an IHI Assessment Scale
reported working on identifying and achieve even lower care failure rates
for Collaboratives score of 5.0
obtaining discharge medications. Few with the use of varying interventions
at the end of the collaborative
sites addressed communication with (Fig 1B).
(Hospitals A, B, C, D), indicating
primary care providers.
Only 4 hospitals reported data on outstanding improvement. One site
Aggregate data for all hospitals family feeling ready for discharge obtained a score of 4.5 (sustainable
combined are depicted in monthly (Fig 2). For these hospitals, there improvement, Hospital E), and 4
run charts. Run charts with individual was a statistically significant sites achieved a 4.0 (significant
hospital trends are available online increase in the percentage of improvement, Hospitals F, G, H, I).
(Supplemental Figures 48). patients who rated the readiness for Two sites were able to test
Eight hospitals reported rates of discharge in the highest category. changes but did not demonstrate
discharge-related care failures. The precollaborative baseline was measurable improvement. Common
Because precollaborative data 85% of patients giving the highest characteristics of the sites that
were not available at most sites, rating; during the last quarter of the achieved a score of 5.0 included
the first quarter of the project was collaborative it was 91% (P < .05). strong multidisciplinary involvement;
used as baseline data. The run The run chart showed a shift of 6 close collaboration with electronic
chart demonstrated a shift, with 10 points above the median line in the medical record (EMR) teams;
consecutive points below the baseline last 2 quarters. dedicated staff time for discharge
median line (Supplemental Figure 4). phone calls, discharge education,
The statistical process control chart Five hospitals reported unplanned and discharge rounding; and use of
(Fig 1B) also confirms this finding, readmission rates for the same discharge checklists.
CONCLUSIONS
This study shows the potential
benefit of the collaborative
approach to improve quality of
inpatient discharges by using an
intervention bundle implemented
in pediatric hospital settings. The
spread of such interventions has the
potential to improve care transition
outcomes for all hospitalized
children.
ACKNOWLEDGMENTS
Expert panel members: Lori
Armstrong, MSN, RN, NEA-BC; Mary
FIGURE 3
Unplanned readmission for the same condition. A, Within 72 hours; B, within 30 days (n = 5 sites Daymont, RN, MSN, CCM, CPUR;
reporting; 7654 discharges). Pamela Kiessling, RN, MSN; Cheryl
Missildine, RN, MSN, NEA-BC; Karen
more effectively plan and monitor opportunity to learn from national Tucker, MSN, RN. Data analysis: Cary
progress of quality improvement experts, share challenges and Thurm, PhD, Childrens Hospital
work. Finally, each site used different successes, learn and adapt from Association.
patient populations and different different settings and patient
tools to collect data, making the populations, and share tools such
data heterogeneous and difficult to as checklists and call scripts. ABBREVIATIONS
compare. The collaborative approach also
CHA:Childrens Hospital
helped sites develop urgency for
Association
Participating sites reported several change at the institutional level
EMR:electronic medical record
benefits of the collaborative model and fostered friendly competition
IHI:Institute for Healthcare
that were consistent with previous and accountability. Teams were
Improvement
studies.51,52 Teams enjoyed the also able to leverage collaborative
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