PC1136: Improving the Critical Transition to Home for Neonates at the Children’s Hospital at Dartmouth

Purpose/Objectives: Poor transitions of care can lead to increased length of stay, increased risk of readmission, and decreased satisfaction with care. Hospital discharge to home is a critical transition of care and currently there is no formal evaluation of this process or standardized follow up by the unit with families after they bring their neonate home. Discharge follow up phone calls have the potential to improve communication, increase attendance at follow up visits and decrease post-discharge complications. This quality improvement initiative aimed to evaluate and improve the current discharge process from the Dartmouth-Hitchcock Intensive Care Nursery (ICN). The SMART aim was to improve discharge checklist use to at least 75% of bed spaces, improve family feedback provided to 50% of families providing feedback by 1 year.

Design/Methods: A multidisciplinary team was formed to address previous challenges identified in the discharge process. Key problems identified included problems with the discharge checklist design and use. Using Plan-do-study-act (PDSA) cycles from April 2021 to April 2022, the discharge checklist was redesigned, specific areas at each bedspace were designated for the checklist, and a family day of discharge survey was initiated. We also implemented follow up phone calls to increase family feedback.
The main outcome measure was parent satisfaction with the discharge process. Balancing measures included time of discharge and length of stay. We followed the percentage of patients using a discharge checklist, families providing contact information as a process measure. Data were analyzed using statistical process control charts to evaluate for special cause variation.

Results: The mean use of the discharge checklist increased from 20.8% to 63.9%, with the largest increase seen after clipboards were placed at bedside to provide a standard location for the discharge checklists to be displayed, indicated by special cause variation shown by a shift (Figure 1). The percentage of families completing the day of discharge survey fell short of the goal of 50%, but all families reported at least moderate satisfaction with the discharge process.

Conclusion/Discussion: Overall, families reported satisfaction with the discharge process, found the newly implemented discharge checklist helpful, and understood and were adherent to the discharge instructions and recommendations. Continued efforts are needed to increase utilization of the discharge checklist, as families overwhelmingly find the checklist helpful, and completion of the day of discharge survey, as it provides an opportunity to identify areas needed for improvement.