Abstracts

Rationale: Healthcare resources, including hospital beds, are a limited resource, and efforts must be undertaken to encourage their efficient utilization. A popular metric for this is “out by noon,” to encourage teams to discharge patients in a timely manner so as to allow new patients to be admitted.Many variables contribute to a patient’s length of hospital stay, including illness severity, healthcare resources, outpatient medications, psychosocial support, social work needs. Pediatric EMU patients represent an ideal patient population for instituting a test of change to improve timely discharges, because several of the above variables can be anticipated. Knowing in advance the patient’s illness severity is one metric that can allow for anticipating the length of stay. Additionally, unique to the EMU, knowing in advance the reason for the LTM can help the multidisciplinary team anticipate which of the patients who are to be admitted over the course of the week could be identified as “early discharges.” Having this information makes it possible to anticipate and plan for the discharge, from the time of admission. This ensures that patient rooms are available for incoming admissions. This study focuses on ways to improve patient flow for EMU patients. Methods: At our hospital, a weekly schedule of EMU admits is sent to the groups of individuals who are involved in the care of the EMU patients, including: the entire Epilepsy division; the pediatric hospitalists and pediatric residents; the charge nurse; case management. The hypothesis was that by engaging both the epilepsy fellow and the nursing specialist on the floor to identify patients who will be admitted the following day, the workflow for both the physician and nursing teams could be modified so that the patient could be discharged as early as possible. EMU patients were categorized by diagnosis type. A formal test of change identifying potential early discharges and communicating this with nursing was implemented with data collection over a 2-week period. The “rule-out ESES” and “differential diagnosis” reasons for admission were identified by neurology as potential early discharges the day prior to the scheduled admission. The primary outcome measure was the unit departure time, which was manually entered by the unit clerk. The secondary outcome measure was the timing of discharge order entry as recorded in the electronic medical record. Results: Prior to this test of change, the baseline rate of discharge by noon was below 20%. With this test of change, 60% of EMU patients and 78% of the identified EMU patients were discharged by noon. Other tests of change are being studied to further improve these outcomes. Conclusions: Nationwide, there is a goal for patients to be discharged early when possible to do so. This is widely accepted in general medicine and general pediatrics specialties, but less so by the subspecialties, including neurology and epilepsy. This study has shown that early identification and communication of potential early discharges can improve efficiency in the use of hospital-wide resources. These findings can be applied to other subspecialties that have scheduled elective admissions. Funding: None.