IHI ID 01 Saving 414 bed days in FY18: discharge planning for patients with new tracheostomies

Background The Progressive Care Unit (PCU) cares for technology dependent children where about 55 patients with newly placed tracheostomy tubes are discharged annually. They are generally discharged to a transitional care center (TCC), where consent and insurance authorization are required, or to home. Home discharges require over 65 hours of caregiver training, home equipment inspections, and home nursing. Most families defaulted to the home discharge plan, although several families were unable to complete all discharge requirements by the time their child was medically stable and no longer needed inpatient level of care. This often caused discharge delays. Objectives Save 100 PCU bed days by June 30, 2018 through enhancing discharge planning. Methods A multidisciplinary team created a Discharge Planning Booklet, which was reviewed with new families. The booklet included eligibility criteria to be discharged to home, an eight-week checklist with all home discharge requirements, a map of TCCs in nearby states, and an opportunity to select an appropriate discharge plan. Results For patients with new tracheostomies, the average PCU length of stay decreased from 77.5 days to 62.2 days, saving 15.3 days per patients. This saved 414 PCU bed days for 27 patients. Several process metrics were also impacted, including decreased training time and decreased days of discharge delay due to incomplete caregiver requirements. Conclusions The project resulted in a unit culture change in the approach to discharge planning for this patient population. In June 2018, the intervention expanded outside of the PCU to three other units, impacting an additional 20 patients each year.