Abstract 12261: Improving Discharge Timeliness on a Pediatric Inpatient Cardiology Unit Through the Implementation of Medical Discharge Criteria Decreases Length of Stay and Reduces Hospital Charges

Background: Prior improvement work integrating standardized medical discharge criteria in general pediatric inpatients led to improved discharge timeliness and reduced length of stay (LOS). Our aim was to develop standardized medical discharge criteria on a quaternary pediatric cardiology unit in an effort to improve the timeliness of discharge. We hypothesized that timely discharge would lead to cost savings and a reduced LOS. Methods and Results: Over 18 months (Jan. 2014 - June 2015), a multi-disciplinary team worked toward the quality improvement aim of increasing the percentage of pediatric cardiology inpatients discharged within 2 hours of achieving medical discharge criteria. We established preset ‘medically ready’ discharge criteria in our hospital EMR, initiated upon admission for all inpatients and modified daily as needed. We organized criteria into 7 categories (congenital heart disease (CHD) medical, CHD post-operative, heart failure/transplant medical, transplant post-operative, electrophysiology (EP) medical, EP post-procedure, and catheterization post-procedure). The median percentage of patients discharged within 2 hours of meeting criteria increased steadily from 35% to 78% over the project period. Concurrently, the median number of patients discharged before noon increased from 18% to 31%. Physician and nursing compliance with necessary process measures was 87% and 89%, respectively. LOS decreased by 8% (3.6 to 3.3 days) from the first 6 months of work to the last 6 months. All-cause readmission remained stable at 15% over the improvement time frame. Review of inpatient charges between Oct. 2014 and June 2015 demonstrated 169 patients (190 discharges) who experienced a delayed discharge based on the set criteria. The sum of charges from care provided after meeting criteria was $231,201 (average of $1,217 per delayed discharge). Conclusions: Discharge timeliness in pediatric cardiology patients can be improved by standardizing medical discharge criteria. We demonstrate that this can be achieved across all subcategories of pediatric cardiology without increasing the rate of readmission. Improved discharge timeliness not only reduces LOS; it provides an opportunity to substantially decrease medical charges.