(1325) Creation of Interprofessional Roadmap to Improve Discharge Efficiency of Patients in the PICU

Introduction: Discharging children with complex medical and social needs, including home nursing and durable medical equipment requirements, is a labor-intensive, time-consuming task. There are often significant discharge related failures leading to prolonged length of stay after patient reaches medical clearance. There are few reports in the literature that directly address this problem for the PICU.

Methods: A QI initiative was undertaken to determine the impact of an interprofessional discharge roadmap for health care providers and families on length of stay. There was shared accountability across disciplines. The roadmap was utilized to guide conversations during discharge rounds. Medically or socially complex children admitted to the PICU in a freestanding children’s hospital between Jan-June 2024 were included. Monthly plan-do-study-act cycles were utilized to assess effect of the interventions.

Results: With initiation of the interprofessional discharge roadmap in the PICU, comparing the last 6 months of 2023 to the first six months of 2024, the percentage of patient with length of stay below benchmarks increased from 65.7% (379 patient encounters) to 71.1% (433 patient encounters). The average encounter LOS for patients only slightly decreased to 7.95 days, compared to 7.97 days in the 6-month prior. PDSA cycles led to small changes to improve compliance in usage across the interprofessional team.

Conclusions: Overall, the development of the discharge process for the medically or socially complex child in the PICU led to a clinically significant improvement in percentage of patients with LOS below benchmark. Sustainability of the initiative will be determined with ongoing evaluation. Given the success of the project, the discharge process map is being considered for utilization in other units throughout the hospital.