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Checklist aids in timely discharge of newborns
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The use of a discharge checklist that facilitated communication between team members improved the percentage of newborns discharged by 11 a.m., according to study results published in Pediatrics.
“Many throughput studies have focused on the emergency department or adult medical units, but this is the only study to date of a quality improvement physician-led initiative addressing throughput in the newborn nursery,” Sandra Cuzzi, MD, pediatric education director at Holy Cross Hospital, associate residency program director at Children’s National Medical center and assistant professor of pediatrics at George Washington University School of Medicine, told Infectious Diseases in Children.
“Numerous studies have documented how checklists can improve safety by standardizing process and fewer studies on its impact to efficiency. But communication has been identified as the most important challenge to patient throughput. Our use of the discharge checklist was to address both safety and efficiency but also to serve as an important communication tool amongst providers.”
Cuzzi and colleagues created and implemented a discharge checklist in an effort to discharge mothers and infants by 11 a.m. at Holy Cross Hospital, the highest volume delivery hospital in Maryland. Mean monthly discharge order times between July 1, 2008, and June 30, 2012, were tracked, and reviews of the charts of 120 newborns discharged during a year also was performed.
The use of the discharge checklist was begun Nov. 5, 2012. The researchers collected data until June 30, 2014.
Of 3,224 newborns at baseline, 24% had been discharged by 11 a.m. At 6 months after implementation of the checklist, an average of 34% of discharge orders were entered by 11 a.m. There were 2,739 infants with a 39% discharge order by 11 a.m. at 20 months after intervention, which when compared with baseline was a 63% increase.
The most frequent cause for a late discharge order was observation of newborns for maternal group B Streptococcus exposure.
“Discharges are a key driver of hospital throughput,” Cuzzi concluded. “A discharge checklist in the newborn nursery improves communication between providers, identifies patient barriers to discharge, and promotes actively resolving those barriers to improve physician discharge order times. Our study also identified the most common barriers to a timely newborn discharge, which may be generalizable and utilized to address throughput issues in many newborn nurseries.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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