Division of Neonatal Medicine.
Department of Nursing, Mayo Clinic, Rochester, Minnesota.
Pediatrics. 2022 May 1;149(5). doi: 10.1542/peds.2021-052759.
Discharge from the NICU is a highly complex process. Multidisciplinary survey results and chart audits identified gaps in the timeliness and efficiency of discharge in our NICU. Using the define-measure-analyze-improve-control quality improvement framework, we aimed to increase the percentage of patients discharged before 11:00 am from a baseline mean of 9.4% to 50% without adversely impacting caregiver readiness to discharge.
We used a fishbone diagram to identify causes of late and inefficient NICU discharge. A Pareto chart and Impact-Effort matrix were used to select targets for improvement efforts. Plan-do-study-act (PDSA) cycles established a goal unit discharge time, created a discharge checklist, prioritized rounding on discharging patients, set expectations for caregiver education completion, and increased nurse knowledge and comfort with providing caregiver education.
The mean percent of patients discharged before 11:00 am increased from 9.4% to 52.4%, exceeding our aim. Median discharge time improved from 13:30 pm to 11:15 am (P < .001). Discharge was more efficient as demonstrated by significantly earlier completion of many discharge tasks. These improvements did not adversely impact reported caregiver readiness to discharge (75% vs 77%, P = .76).
Quality improvement methods can significantly improve the timeliness and efficiency of NICU discharge. Improvement in this complex process may be facilitated by a multidisciplinary team that offers diverse perspectives, unique process and methodologic knowledge, and the ability to appeal to all unit stakeholders. Lessons learned from this project may benefit other teams working to improve their ICU discharge process.
新生儿重症监护病房（NICU）的出院流程非常复杂。多学科调查结果和病历审核发现，我们的 NICU 在出院及时性和效率方面存在不足。我们使用“定义-测量-分析-改进-控制”（DMAIC）质量改进框架，旨在将上午 11 点前出院的患者比例从基线时的 9.4%提高到 50%，同时不影响患者家属的出院准备情况。
我们使用鱼骨图来确定导致 NICU 出院时间延迟和效率低下的原因。帕累托图和影响-努力矩阵用于选择改进措施的目标。计划-执行-研究-行动（PDSA）循环设定了目标单位出院时间，创建了出院检查表，为即将出院的患者优先进行查房，设定了完成患者教育的期望，并提高了护士提供患者教育的知识和舒适度。
上午 11 点前出院的患者比例从 9.4%提高到 52.4%，超过了我们的目标。中位数出院时间从下午 1 点 30 分提前到上午 11 点 15 分（P<0.001）。许多出院任务完成得更早，表明出院效率更高。这些改进并没有对报告的患者家属出院准备情况产生不利影响（分别为 75%和 77%，P=0.76）。
质量改进方法可以显著提高 NICU 的出院及时性和效率。多学科团队可以为这一复杂过程提供不同的视角、独特的流程和方法知识，以及吸引所有单位利益相关者的能力，从而有助于改进这一过程。从这个项目中吸取的经验教训可能会使其他团队受益，帮助他们改进 ICU 出院流程。
