SHM Converge Scientific Abstract ePoster Gallery-Evaluating the Discharge Process and Education in a Children's Hospital

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This study evaluated pediatric discharge education at Children’s Hospital of the King’s Daughters to identify weaknesses in the discharge process and opportunities to improve caregiver understanding, safety, and readmission outcomes. The authors noted that discharge education often lacks standardization and clear communication among care-team members, which can lead to errors, dissatisfaction, and avoidable healthcare use.<br /><br />To understand the process, summer scholars observed daily rounds and discharge education, interviewed team members, and created questionnaires to measure caregiver comprehension, nurse prediction of caregiver understanding, and 7-day return visits to the hospital or emergency department. They also developed a detailed process map of the discharge workflow.<br /><br />The final process map included more than 75 steps performed by six different provider roles, and the team identified over 20 specific improvement opportunities. Examples included making discharge criteria sets available to all residents, starting medication reconciliation during rounds, allowing drafts to be cross-checked by attendings, and adding fax and resident phone numbers to prescriptions to help with prior authorizations.<br /><br />Among 87 caregivers, average comprehension was high (91.1%), and nurse assessments were even higher (95.7%). However, nurses rated understanding significantly higher for white caregivers than for Black caregivers, despite no significant difference in caregiver test scores by race. A 20% discrepancy between nurse assessment and caregiver score was considered important, but this difference was not significantly associated with readmissions or ER visits. Overall, caregiver scores, nurse assessments, and their differences were not significantly linked to 7-day hospital readmission or ER use.<br /><br />The study concludes that process mapping revealed important workflow and communication problems that could be addressed through EMR improvements, clearer team roles, and better coordination, potentially improving discharge safety and reducing readmissions.

Asset Subtitle

Benjamin L. Chilampath

Meta Tag

Author List Benjamin L. Chilampath, Heather Beatty, Kyrie Shomaker, Reyna Nikolaus, Turaj Vazifedan

Category Research

Concept Pediatric Discharge Education

Concept Caregiver Comprehension

Concept Standardization

Concept Miscommunication

Concept Process Mapping

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School / Children's Hospital of the King's Daughters

Presenting Author Benjamin L. Chilampath

Track Quality Improvement

Keywords

pediatric discharge education

process mapping

caregiver comprehension

hospital readmission

discharge workflow

care coordination

medication reconciliation

nurse assessment

emergency department visits

patient safety

Pediatric Discharge Education

Caregiver Comprehension

Standardization

Miscommunication

Process Mapping