Key result
Standardized discharge interventions cut 72-hour return rates by ~8% versus baseline.
Why the study?
Unscheduled return visits within 72 hours of discharge are a quality indicator of pediatric emergency department care and account for 4% of visits annually.
Do standardized discharge interventions reduce 72-hour return rates in pediatric emergency department and urgent care patients?
Do standardized discharge interventions reduce 72-hour return rates in pediatric emergency department and urgent care patients?
Standardizing discharge workflows and implementing teach-back education significantly reduces 72-hour return visits in pediatric emergency and urgent care settings.
Answers are grounded in this paper and cite their sources.
Discharge process improvements may lower pediatric 72-hour ED returns; leaves open generalizability and requires controlled validation.
Introduction: Unscheduled return visits within 72 hours of discharge account for 4% of pediatric emergency department (ED) visits each year and are a quality indicator of ED care. This project aimed to reduce the unexpected 72-hour return visit rate for a network of ED and urgent cares (UC) by improving discharge processes. Methods: A multidisciplinary team conducted a quality improvement initiative in the EDs/UCs of a tertiary children’s hospital network. The team developed discharge interventions through successive Plan-Do-Study-Act cycles. They included standardization of the electronic health record discharge workflow and implementation of “mini-after care instructions” and teach-back education. The team used a statistical process control chart to follow the 72-hour return rate, and a chi-square test to compare the pre- and post-intervention 72-hour return rate. Results: The ED/UC network discharged 219,196 patients during the study, 12/2014–4/2016. The baseline 72-hour return rate was 3.5% before interventions. The team implemented discharge interventions from 12/14 to 9/15. After the implementation of mini-after care instructions (4/15), 8 consecutive points fell below the mean on the statistical process control chart, and there was an 8.2% reduction in the 72-hour return rate ( P < 0.01). Admission rates of 72-hour return patients remained stable throughout the study (27% pre-intervention and 28% post-intervention). Improvements to the ED/UC discharge process resulted in the estimated prevention of 600 ED/UC visits annually throughout the network. Conclusions: Quality improvement methodology and multidisciplinary enhancement of discharge processes significantly decreased 72-hour return rates across a network of pediatric EDs and UCs.
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Navanandan et al. (2020) studied Pediatric emergency department and urgent care visits (n=219,196). Standardized discharge interventions (EHR workflow, mini-after care instructions, teach-back education) vs. Baseline (pre-intervention) was evaluated on 72-hour return rate (8.2% reduction, p=< 0.01). Standardized discharge interventions, including mini-after care instructions and teach-back education, reduced the 72-hour return rate by 8.2% compared to baseline.
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