Stansbury Nicholas, Marlow Taylor Richard, Wueste Beth
University of Texas Health San Antonio, San Antonio, Tex.
Pediatr Qual Saf. 2021 Dec 15;6(6):e497. doi: 10.1097/pq9.0000000000000497. eCollection 2021 Nov-Dec.
Lack of bed availability is a common problem in our pediatric unit, as in many hospitals. To address this issue, we instituted a quality improvement (QI) initiative involving collaborative nurse-physician rounding. This intervention has been shown to expedite discharge, improve patient care, and increase bed availability in other settings.
By utilizing PDCA (Plan, Do, Check, Act) processes, we created two improvement initiatives, "Increasing Patient Discharge Before 12 pm" and "Midnight Rounds with Discharge Focus." Senior resident and faculty physicians rounded on discharge-ready patients before teaching rounds, and by 10 am, placed discharge orders to allow for a 12 pm discharge. A night team consisting of senior residents and nurses conducted "Midnight Rounds" and identified potential discharges for the morning team. The project aimed to increase patient discharges before 12 pm from a June-November 2018 baseline of 15%-20% by June 2019.
Patient discharge percentage before 12 pm increased from 15% to 21% ( < 0.01) by June 2019, and as a result, bed availability increased by 16% ( < 0.01).
QI methodology clarified the root causes of limited bed availability. Understanding the existing discharge process allowed for QI initiatives to develop a consistent and sustainable discharge process. Patient discharge percentages before 12 pm increased by 40%, and bed availability increased by 16% after QI implementations.
与许多医院一样，床位短缺是我们儿科病房常见的问题。为解决这一问题，我们发起了一项质量改进（QI）计划，其中包括护士与医生协作查房。在其他环境中，这种干预措施已被证明可以加快出院速度、改善患者护理并增加床位可用性。
通过运用PDCA（计划、执行、检查、行动）流程，我们制定了两项改进计划，即“增加中午12点前患者出院人数”和“以出院为重点的午夜查房”。高级住院医师和带教医师在教学查房前对已准备好出院的患者进行查房，并在上午10点前下达出院医嘱，以便患者在中午12点出院。由高级住院医师和护士组成的夜间团队进行“午夜查房”，为上午的团队确定可能出院的患者。该项目旨在到2019年6月将中午12点前的患者出院率从2018年6月至11月的基线水平15%-20%提高。
到2019年6月，中午12点前的患者出院率从15%提高到了21%（P<0.01），床位可用性因此增加了16%（P<0.01）。
QI方法明确了床位可用性受限的根本原因。了解现有的出院流程使QI计划能够制定出一致且可持续的出院流程。实施QI后，中午12点前的患者出院率提高了40%，床位可用性增加了16%。
