G54(P)\u2005Using quality improvement methodology to implement a short stay admission policy for children in a quaternary scottish paediatric hospital

Abstract

Rising service demand, staffing pressure and a planned move to a new site prompted a trial of a new discharge process at a Scottish Paediatric Hospital. Our aim was to use quality improvement methodology with process mapping of systems, delineating good and bad variation and multiple PDSA cycles to measure the effectiveness of a Short Stay Policy (SSP) for acute general paediatric admissions. This policy streamlined patient discharge processes by empowering the middle grade team to discharge patients prior to the medical consultant ward round the next day. The Standard Policy (StP) only enabled consultants to discharge children. As low acuity stable children would be seen later on the ward round, some patients waited an additional 4 to 8\u2009hours for the decision to discharge. We aimed to calculate the potential time, personnel and financial savings made by this new policy, and to ensure it maintained a high quality, safe service. Our study grouped patients into those seen through the SSP, and those through StP. Patient journeys were mapped and our online patient record (TRAK) was used to assess timings along the pathway and total length of stay. A Delphi group established which diagnoses and types of patients could be included in the SSP and readmissions rates were considered with qualitative surveys gathered to understand child and family experience. An inpatient admission costs £400 per child in a 24\u2009hour period. The SSP saved an average of 12.1\u2009hours per patient saving £200 per patient. Detailed patient notes demonstrated the same level and quality of care was experienced by the patient. 100% of parents contacted indicated feeling happy and comfortable at discharge. Spending less time in hospital meant patients and parents got home sooner, saving time off work/school and ensuring their hospital admission caused minimal disruption to their activities. This project demonstrates that implementing ‘good variation’ in patient process whilst using sound methodology to investigate tests of change, can result in improved child and family experience, systems change and financial efficiency.