747 - Improving Family Discharge Readiness in Hospitalized Pediatric Patients

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 747
Publication Number: 747.414

Lucia An, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Francesca H. Corley, University of California Los Angeles, Los Angeles, CA, United States; Ozioma Obiwuru, UCLA, Los Angeles, CA, United States; Chelsea Pan, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Deepa Kulkarni, UCLA Mattel Childrens Hospital, Los angeles, CA, United States; Yamini Sharma, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Audrey Kamzan, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States

Presenting Author(s)

Audrey Kamzan, MD (she/her/hers)

Division Chief, Pediatric Hospital Medicine
UCLA Mattel Childrens Hospital
Los Angeles, California, United States

Background: Patient perception of poor discharge preparedness has been associated with more difficulty coping after discharge, more follow-up concerns, and higher likelihood of readmission. Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a validated survey of parents of hospitalized pediatric patients that assesses several domains, including discharge preparedness. Survey top box scores, which are the percentages of respondents that choose the top positive response options, are used to compare performance between hospitals and to develop patient experience improvements.

Objective:

Our objective was to use quality improvement (QI) tools to understand the current discharge process to develop our aim and change ideas.

Design/Methods: We interviewed stakeholders, which included nurses, case managers, social workers, pharmacists, and residents and surveyed patient families 2 to 4 weeks after discharge to measure importance and completeness of discharge components. We created a Pareto chart (Figure 1) from patient survey data and a driver diagram (Figure 2) from surveys, stakeholder input, and data from a subset of discharge questions from Child HCAHPS survey.

Results: Our outcome measure was the top box score from Child HCAHPS survey. Baseline data from December 2021 to October 2022 showed a mean score of 80% (Figure 3), which is below the 50th percentile of national data. Our Pareto chart demonstrated after visit summaries (AVS), discharge communication, and home supplies as components with the least number of parents “agreeing” or “strongly agreeing” they were complete during their discharge process. Using this data, our process measure was the proportion of AVS that contain activity restrictions, return precautions, and care instructions with baseline median 36%, 91%, and 5%, respectively. Our balance measure was residents’ satisfaction with the discharge order set used to create the AVS using a 5-point Likert scale (1 = “extremely dissatisfied, 5 = “extremely satisfied”). Median baseline resident satisfaction with the discharge order set was “somewhat dissatisfied.”

Conclusion(s): Our aim is to increase Child HCAHPS top box score in discharge preparedness in 12 months from a baseline of 80% to 86.4%, which is the 90^th percentile national rank. Based on our current discharge process assessment, we will standardize AVS by discharge order set changes, create a pediatric durable medical equipment order set, and develop a discharge checklist for family centered rounds.