Early hospital discharge is an important quality improvement measure that has not been well studied in pediatric neurology. The objective of our study was to implement strategies to improve hospital discharge times for patients admitted to the pediatric neurology service.

Discharge planning requires a collaborative approach involving a multidisciplinary team of attending physicians, fellows, residents, nurses and social workers working in conjunction with patients and their families. It can be a delicate and complicated process. Late discharges can have a cascade effect contributing to admission delays, unnecessary boarding in emergency departments, ICUs and other hospital units leading to an increased census and overcrowding. With this in mind, we decided to implement a quality improvement project with a goal of discharge before noon (DBN) as our primary objective
 

This was a quality improvement (QI) study of hospital DBN in pediatric neurology patients admitted to a tertiary children’s hospital from December 2017 to May 2018. Inclusion criteria were age 0-18 years old patients with a primary neurological diagnosis on admission. We excluded patients discharged on weekends. Demographic and clinical data were collected, including age, gender, race and reasons for delay in discharge. Chi square, t test and survival analysis were performed to determine differences between baseline and post QI implementation.

One hundred ninety-one patients were included in the study. There were 76 subjects before the implementation of the study and 115 subjects during the study. DBN percentage increased in the first three months of the intervention period in an exponential manner; from a baseline of 40.7% to 60.8%. Survival analysis showed discharge time after QI implementation improved significantly (log rank χ²= 4.102, p=0.043).

This is the first study to identify the factors associated with late discharge and successful strategies to improve DBN in an inpatient pediatric neurology setting.