The QI Project that Helped a Children's Hospital Improve Patient Flow

The QI Project that Helped a Children's Hospital Improve Patient Flow

Through a more efficient discharge system, Cincinnati Children’s reduced costs to families and insurers, and improved the overall patient experience.

After winning a 2013 Pediatric Quality Award, Cincinnati Children’s Hospital Medical Center dramatically increased efficiency in its patient discharge process, improved substantial cost savings, made more beds available for additional patients and—perhaps most importantly—improved the overall experience for patients and their families.

Those award-winning achievements sprung from testing in which Cincinnati Children’s developed standard discharge criteria for 11 common inpatient diagnoses based on available evidence and expert consensus. The information was embedded in the electronic medical record (EMR), allowing for a new discharge process focused on patient needs first, discharging them when they are medically ready.

Though the initial testing was successful, today, the project work continues. Could the concept scale across the rest of the hospital’s patient population to create standardized discharge protocols for hundreds of diagnoses?

“It can be more challenging with different diagnoses, but we had leaders in each service line create the criteria for their own patients—they know what they’re looking for,” says Angela Statile, M.D., M.Ed., assistant program director, Pediatric Residency Training Program at Cincinnati Children’s Hospital Medical Center. “That made it easier, because they could create the diagnosis-specific criteria that works for their team.”

Nearly $6 million saved—but that’s not the primary goal

In the initial testing, Cincinnati Children’s saw a 38% increase in patients discharged within two hours of being medically ready, resulting in an estimated cost savings of $5.9 million. And while those first 11 trial diagnoses covered about 15% of inpatient services, today that number stands at 90%. But perhaps the most notably improved metric has been the number of patients in the hospital’s care.

“We didn’t do this project because of the cost savings but rather to accommodate more patients,” says Christine White, M.D., MAT, associate chief of staff, inpatient services at Cincinnati Children’s Hospital Medical Center. “When we started this project, the high end of our census for inpatient services was 400 patients, but now we are routinely over 500 patients—often over 550—without increasing many beds. That really speaks to the impact the improvements in our discharge efficiency has had.”

Families appreciate shared goals, transparency

Feedback from patient families on the discharge processes has been overwhelmingly positive, according to Statile and White. They say having shared goals toward patient discharge—and transparency throughout the process—makes for a substantially improved patient and family experience. And they’ve seen firsthand how having that information empowers families.

“We see some families now actually asking us for their discharge criteria and checking it off on the board,” White says. “The families have really appreciated having it.”

Two keys to successful implementation

Statile says Cincinnati Children’s continues to collect data and more information on the hospital’s learnings should be published soon. But she adds there are two key factors to consider for successfully implementing a discharge criteria protocol:

  • Involve everyone. It’s critical to have the primary stakeholders on board from the beginning—including nurses, doctors, case managers and families—everyone who will be involved with patient discharge should be represented. “Having them there at the table to start will enable you to create goals that are most appropriate for your patients,” Statile says.
  • Don’t go too small. The natural inclination when implementing any new process is to begin with a small trial group, but resist the urge to limit the size of the rollout. “When we’ve expanded this to a new service or unit, we’ve encouraged them to work on their entire group of patients,” Statile says. “We’ve found it’s hard when you’re doing just certain diagnoses or a couple of patients to remember the process.”

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