Improving Communication Around Discharge Readiness at a Satellite Children’s Hospital: A Single-site Improvement Initiative

Introduction: Discharge efficiency enhances hospital throughput, enabling timely, appropriate care while improving patient/caregiver experience and provider satisfaction. Prior efforts at our institution focused on implementing a discharge workflow based on the early identification of medical discharge goals. However, our satellite hospital team lacked consistent nurse-driven discharge activation when patients met these goals, which could delay the identification of discharge readiness. We aimed to increase the percentage of patients for whom nurses identified discharge readiness and activated the discharge process from 28% to 60% within 6 months. Methods: A multidisciplinary team applied quality improvement methods to identify key drivers and implement targeted interventions. Interventions included process education, structured communication during rounds, targeted feedback and email reminders, scheduled rounding times, and use of conditional discharge orders. We tracked the primary measure, the percentage of patients with nurse-driven discharge activation, using a statistical process control chart. Secondary measures included the percentage of patients with nurse-documented discharge readiness, the percentage of patients discharged within 2 hours of meeting medical discharge goals, and hospital length of stay. We monitored 7-day readmission rates as a balancing measure. Results: The mean percentage of patients with nurse-driven discharge activation increased to 67% and remained above this level for more than 8 months. The percentage of patients with nurse-documented discharge readiness improved from 71% to 86%; the mean percentage of patients discharged within 2 hours of nurse-identified readiness increased from 85% to 89%. Length of stay and 7-day readmission rates were unchanged. Conclusions: Through multidisciplinary efforts to improve process transparency and collaborative communication frameworks, we enhanced nurse-driven discharge activation at a satellite children's hospital.