Addressing the Inpatient Capacity Crunch: A Quality Improvement Initiative to Increase Expected Discharge Date Documentation

Introduction

Pediatric hospital capacity has decreased nationally, leaving hospitals vulnerable to capacity constraints. Approximately one fourth of pediatric patients experience discharge delays secondary to poor planning and miscommunication. As part of a hospitalwide quality improvement effort to decrease length of stay (LOS) through improved communication, an interdisciplinary team sought to increase expected discharge date (EDD) documentation for discharges on six low-performing teams from 14.2% to 50% by February 2023, inclusive of Child Opportunity Index (COI).

Methods

The team identified three primary drivers of EDD documentation: knowledge, logistics, and competing priorities. Interventions to address these drivers were implemented through eight Plan-Do-Study-Act cycles and the impact analyzed via statistical process control charts. Measures included EDD documentation (primary outcome measure), LOS (secondary outcome measure), discussion of the EDD per patient (process measure), rounding time, discharge by noon, and EDD accuracy (balancing measures).

Results

A total of 18,889 discharges were included during the baseline (July 2021 to August 2022) and intervention (September 2022 to August 2024) periods. EDD documentation demonstrated special cause variation, increasing from 14.2% to 55.7%, and was sustained for 20 months. Improvement was consistent across COI with 93.94% accuracy. LOS and rounding time were unchanged. Discussion of the EDD per patient decreased from 38.9% to 29.4%.

Conclusion

Although this effort did not decrease LOS, EDD documentation increased. This provided real-time data for more than 12,000 discharges during the intervention period. EDD documentation may serve as a valuable tool for institutional leaders to inform capacity management strategy.