Eksambe Padmavati, Shah Yash D, Singh Kanwaljit, Stennett Joy, Lauretta Emma, Sy-Kho Rose Marrie, Kim Joshua, Ascher Catherine, Karkare Shefali, Kothare Sanjeev
Division of Child Neurology, Department of Pediatrics (PE, YDS, JS, EL, RMSK, JK, CA, S. Karkare, S. Kothare), Cohen Children's Medical Center, New Hyde Park, NY; and Department of Pediatrics (KS), University of Massachusetts Medical School, Worcester, MA.
Neurol Clin Pract. 2020 Jun;10(3):214-221. doi: 10.1212/CPJ.0000000000000715.
Early hospital discharge is an important quality improvement (QI) measure that has not been well studied in pediatric neurology. The objective of our study was to implement strategies to improve hospital discharge times for patients admitted to the pediatric neurology service.
This was a pilot QI study of hospital discharge before noon (DBN) in pediatric neurology patients admitted to a tertiary care children's hospital. The study duration was 6 months (12/2017-05/2018)-first 3 months preintervention and next 3 months postintervention. Strategies focusing on preidentifying MRI candidates and those needing home care services, identifying pharmacy preference, reviewing overnight video EEGs first thing in the morning, and implementing morning huddles, etc., were implemented. Demographic and clinical data were collected, including age, sex, race, and reasons for delay in discharge. Chi-square, test, and survival analysis (log-rank test) were performed to determine differences between baseline and post-QI implementation.
One hundred ninety-one patients were included in the study. There were 76 participants before the implementation of the study and 115 participants during the study. DBN percentage increased in the intervention period, from a baseline of 40.7% to 60.8%. Survival analysis showed that the discharge time after QI implementation improved significantly ( = 0.043).
Our study successfully identified the factors associated with late discharge and developed effective strategies to improve DBN in an inpatient pediatric neurology setting
早期出院是一项重要的质量改进（QI）措施，但在儿科神经病学领域尚未得到充分研究。我们研究的目的是实施策略，以缩短儿科神经病学服务住院患者的出院时间。
这是一项针对三级儿童专科医院收治的儿科神经病学患者中午前出院（DBN）的试点QI研究。研究持续6个月（2017年12月至2018年5月），前3个月为干预前，后3个月为干预后。实施了一系列策略，包括预先确定MRI检查候选人及需要家庭护理服务的患者、确定药房偏好、在早晨第一件事时查看夜间视频脑电图以及开展晨间碰头会等。收集了人口统计学和临床数据，包括年龄、性别、种族以及出院延迟的原因。进行卡方检验、t检验和生存分析（对数秩检验），以确定基线与QI实施后之间的差异。
191例患者纳入研究。研究实施前有76名参与者，研究期间有115名参与者。干预期间DBN百分比增加，从基线的40.7%升至60.8%。生存分析表明，QI实施后的出院时间显著改善（P = 0.043）。
我们的研究成功确定了与出院延迟相关的因素，并制定了有效的策略来提高住院儿科神经病学患者的DBN。
