Pediatric Ward Discharge Quality Improvement
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT03153722|
Recruitment Status : Completed
First Posted : May 15, 2017
Last Update Posted : April 20, 2021
|Condition or disease||Intervention/treatment||Phase|
|Pediatric Hospitalization||Procedure: Pediatric discharge process interventions||Not Applicable|
Hospital crowding has been associated with increased hospital length of stay in pediatric populations and adverse outcomes in adult populations. This study focuses on a 36-bed general pediatric inpatient care unit whose occupancy has seen exponential growth over the past several years. With the growth in patient population, the study hospital is experiencing increasing difficulty with hospital crowding, particularly during key times of year, such as the winter viral respiratory season. During these times, pediatric patients may experience high emergency room wait times, and admitted patients may be required to board in the emergency room or post-anesthesia care unit while they await an inpatient bed. Lack of inpatient bed availability has also, at times, required cancellation of surgical cases and denial of outside hospital patient transfers to the institution, resulting in inconvenience to patients and delays in care.
The pediatric hospital discharge process has come under particular scrutiny as an area in which both the efficiency and the effectiveness of patient care can be improved. Currently, around 10% of patients ready for discharge in a given day from the general pediatric hospitalist service are discharged prior to noon, freeing up this bed space for a new patient. While for some patients, discharge is postponed for medical reasons, others must remain in the hospital for non-medical delays. For example, they may remain hospitalized because they have not yet been seen by a physician, their medications are not available for pick-up from the pharmacy, or they do not have transportation from hospital to home. Several studies in pediatric populations have shown that quality improvement processes can improve discharge efficiency without compromising care quality or patient/family satisfaction. The investigators aim to determine if an iterative quality improvement process can reduce barriers to discharge and therefore decrease pediatric patients' length of stay. They will simultaneously analyze several secondary outcomes to evaluate patient flow, patient/family satisfaction, and subsequent hospital utilization to evaluate for unintended consequences of the interventions.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||5478 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Health Services Research|
|Official Title:||Pediatric Ward Discharge Quality Improvement|
|Actual Study Start Date :||May 15, 2017|
|Actual Primary Completion Date :||December 31, 2020|
|Actual Study Completion Date :||December 31, 2020|
Experimental: Pediatric discharge process intervention
All patients hospitalized on the pediatric ward under the pediatric hospitalist service will participate in pediatric discharge process interventions.
Procedure: Pediatric discharge process interventions
As this is an iterative quality improvement process, interventions will be evidence-based and chosen to test effectiveness for addressing areas of discharge bottlenecks or inefficiency within our specific hospital's context. Examples of possible interventions may include implementation of a discharge risk assessment (as in Statile et al, Pediatrics 2016), institution of a "medications-in-hand" policy on hospital discharge (as in Sauers-Ford et al, Pediatrics 2016), or initiation of a ward discharge coordinator who will help coordinate outpatient follow-up for patients. Interventions will be implemented in a stepwise fashion, utilizing successive plan-do-study-act cycles, with a minimum 2 month period between interventions to monitor outcomes.
- Length of stay index [ Time Frame: Time from admission to discharge through study completion in 1 year. ]Length of stay index is a metric that is calculated by Vizient and compares a patient's hospital length of stay to national averages, taking into account the patient's diagnosis, severity of illness, and disease complexity.
- Percentage of patients discharged before 1200 [ Time Frame: Discharge time for each patient within a 24 hour period on day of discharge. ]Percentage of pediatric hospitalist patients who are discharged before noon on the day they are eligible for discharge.
- Readmission [ Time Frame: 30 days ]Same hospital 30 day readmission rate
- Emergency department re-visit [ Time Frame: 7 and 30 days ]Same hospital 7- and 30-day emergency room revisit rate
- Patient satisfaction [ Time Frame: Mailed to families following hospital discharge through study completion in 1 year. ]Patient/family hospital discharge satisfaction scores, as measured on the Child Hospital Consumer Assessment of Healthcare Providers and Systems (CHCAHPS), which is sent to each family after their child is discharged from the hospital.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03153722
|United States, California|
|University of California Davis|
|Sacramento, California, United States, 95817|