6818 Safe to leave? Improving the discharge process from a children’s emergency department

Objectives From two significant incidents that happened in our children's emergency department (CED), we learned that improvements could be made in the discharge process. As such 'Safer Discharge' criteria were created to standardise our discharge practices. A baseline 10-week audit showed that adherence to these 7 criteria was poor.1 Methods The IHI model for improvement methodology was used to gather data weekly for 36 weeks. We aimed to engage the whole CED team in identifying barriers to criteria adherence through surveys and informal discussions and from these, solutions were created and tested using PDSA cycles. Education sessions, a visual education board, new discharge leaflets, 'Trolley Dashes' and a tick-box discharge checklist to facilitate documentation were interventions that were implemented. 'Safe Discharge Champions' also helped to maintain momentum. Team engagement was maintained through regular communication of results via the weekly newsletter, a departmental social media group and formal departmental meetings. External factors such as changeover of junior staff and doctors' strikes were also noted on the run-charts as potential influencers of weekly results. Results Significant improvement has been seen across all the domains at various points over this time course. The largest improvements have been within documenting a repeat pain score, documentation of verbal safety-net advice given and documentation of a discussion of the progression of illness – these have shown the most improvement with the results each week consistently above the baseline audit median line. The documentation of 'written safety-net advice given' remains the one criteria in which sustained change has been difficult to achieve. The timing of when poor performance in this criterion occurs, suggests that changeover in staff and strike action impact performance. Conclusion Embedding change in a department's culture is challenged by staff changeover, time and resource constraints. Solutions can be found in educating and empowering the whole team through change champions, regular communication and taking a multi-solution approach to the complex problem of safely discharging patients from a busy CED. References Holmes B, Ahmed F, Arsanious M, James, D, Pryde K. Safe to leave? An audit of discharges from a children's emergency department, RCPCH Conference. May 2023