(Research Hub Theater) Decreasing Time to Discharge to Pediatric Inpatient Rehabilitation: A Quality Improvement Project

Background and/or Objectives: Delayed hospital discharges can worsen patient outcomes and increase costs. We identified concerns that pediatric patients referred for inpatient rehabilitation had high rates of avoidable hospital days prior to final discharge. We hypothesized that lack of standardized preparation for discharge contributes to delays in discharge. We aimed to develop a tool in the electronic health record (EHR) to standardize tracking patient medical readiness for discharge and to reduce avoidable hospital days.

Design: This QI project involved retrospective chart review of all pediatric patients referred for inpatient rehabilitation between 05/01/22 to 10/31/22 to collect baseline data and qualitative surveys after implementation of the interventions.

Setting: Single academic pediatric acute care hospital

Participants: Children aged 0-21 recommended to receive inpatient rehabilitation; acute care case managers

Interventions: We developed an EHR tool tracking identification of medical readiness for discharge. From initial results and qualitative interviews with discharge case managers, further intervention was required. We developed guidelines for medical readiness for discharge to IRF. Subsequent surveys and EHR data track how avoidable hospital days are affected.

Main Outcome Measures: Primary: Identification of medical readiness for discharge to inpatient rehabilitation. Secondary: Reduction in avoidable hospital days.

Results: Prior to implementation of the EHR tool, 99% of patients were not marked medically ready for discharge, with 59 total avoidable patient hospital days. Two months after implementation and education on the tool, 96% of patients were not marked medically ready, and total avoidable hospital days were reduced to 38.

Conclusions: The presence of an EHR tool to document medical readiness reduced avoidable hospital days by 36%, with the majority of patients still not identified as medically ready for IRF due to team and case manager discomfort. As a result of this study, we developed guidelines for primary teams to proactively work toward identifying medical readiness, with subsequent surveys of team confidence on identifying medical readiness.