Introduction: Recent postpandemic respiratory viral surges have highlighted challenges in inpatient capacity at children's hospitals. Our hospital identified a key bottleneck affecting our ability to accommodate patients: afternoon discharge clustering. We sought to improve throughput efficiency by increasing the percentage of patients discharged outside peak hours.
Methods: We established an interdisciplinary committee to study our discharge process. We obtained baseline data from January 2021 to April 2022 and determined our peak discharge hours, 11 am-5 pm, when 72% of discharges occurred. Key drivers were identified using the model for improvement, and interventions were trialed using plan-do-study-act cycles. Percent of patients discharged outside peak hours was determined using statistical process control charts (p-charts) as our primary measure. We aimed to improve this percentage by 20% from baseline. Secondary measures were the percentage of discharge orders placed before 9 am and the percentage of patients discharged before 11 am. Balancing measures included average hospital length of stay, discharge turnover time, and patient satisfaction surveys.
Results: The mean percentage of nonpeak discharges between 5 pm and 11 am increased from a baseline of 28% to 36%. Discharge orders placed before 9 am increased from 4% to 16%. Patients discharged before 11 am increased from 7% to 19%. There were no significant changes in length of stay, discharge turnover time, or patient satisfaction with the discharge process. Key interventions included stakeholder involvement and incentives to support faculty and trainee workflow adjustments, including rounding practices.
Conclusions: Our team increased the percentage of patients discharged during nonpeak hours and promoted discharge when medically ready.
