Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Quality Improvement Article
  • Published:

Optimizing the hospital discharge process to facilitate family-centered care for well newborns

Journal of Perinatology volume 43, pages 952–957 (2023)Cite this article

Subjects

Abstract

Background

The perceptions of discharge readiness differ among caregivers and providers. An efficient planning process ensures timely attainment of discharge readiness. Our aim was to increase the percentage of discharge orders placed by 10 a.m. from 0.5% to 10% within 6 months thereby improving discharge readiness.

Methods

We conducted a quality improvement initiative in the newborn nursery between March 2021 and June 2022 (n = 2307). We implemented a physician-led early discharge huddle and standardized the newborn screen (NBS) and circumcision process.

Results

By 10 a.m., our primary outcome measure, discharge orders, improved from 0.5 to 19%. Our process measures also increased. NBS specimens collected improved from 56 % to 98 % and circumcision rates increased from 66 to 88%. Balancing measure of postpartum hospital days remained stable.

Conclusions

Optimizing family-centered discharge processes by addressing key drivers is essential and can be achieved without an increase in postpartum hospital days.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Pareto chart depicting reasons for discharge delays in descending order of frequency.
Fig. 2: Fishbone diagram summarizing reasons for delays in discharge readiness.
Fig. 3: Driver diagram.
Fig. 4: Process and outcome measures.

Similar content being viewed by others

References

  1. Gonçalves-Bradley DC, Lannin NA, Clemson LM, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev. 2016;2016:CD000313.

    PubMed  PubMed Central  Google Scholar 

  2. Bernstein HH, Spino C, Finch S, Wasserman R, Slora E, Lalama C, et al. Decision-making for postpartum discharge of 4300 mothers and their healthy infants: the Life Around Newborn Discharge study. Pediatrics 2007;120:e391–e400.

    Article  PubMed  Google Scholar 

  3. Huber DL, McClelland E. Patient preferences and discharge planning transitions. J Prof Nurs. 2003;19:204–10.

    Article  PubMed  Google Scholar 

  4. Cadel L, Guilcher SJT, Kokorelias KM, Sutherland J, Glasby J, Kiran T, et al. Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ Open. 2021;11:e044291.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29:160–8.

    Article  PubMed  Google Scholar 

  6. Mustafa A, Mahgoub S. Understanding and overcoming barriers to timely discharge from the pediatric units. BMJ Qual Improv Rep. 2016;5:u209098.w3772.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rochester NT, Banach LP, Hoffner W, Zeltser D, Lewis P, Seelbach E, et al. Facilitating the timely discharge of well newborns by using quality improvement methods. Pediatrics 2018;141:e20170872.

    Article  PubMed  Google Scholar 

  8. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016;25:986–92.

    Article  PubMed  Google Scholar 

  9. Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003;12:458–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Benneyan JC. Use and interpretation of statistical quality control charts. Int J Qual Health Care. 1998;10:69–73.

    Article  CAS  PubMed  Google Scholar 

  11. Provost LP, Murray SK. The health care data guide: learning from data for improvement. San Francisco, CA: Jossy-Bass; 2011

  12. Warsame R, Kasi PM, Villasboas-Bisneto JC, Gallenberg D, Wolf R, Ward J, et al. Transition of care for inpatient hematology patients receiving chemotherapy: development of hospital discharge huddle process and effects of implementation. J Oncol Pr. 2016;12:e88–e94.

    Article  Google Scholar 

  13. Tielbur BR, Rice Cella DE, Currie A, Roach JD, Mattingly B, Boone J, et al. Discharge huddle outfitted with mobile technology improves efficiency of transitioning stroke patients into follow-up care. Am J Med Qual. 2015;30:36–44.

    Article  PubMed  Google Scholar 

  14. Clay AM, Parsh B. Patient- and family-centered care: it’s not just for pediatrics anymore. AMA J Ethics. 2016;18:40–4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr Manimaran Ramani and Dr Keith Peevy for critically reviewing the manuscript for important intellectual content. We also thank the entire newborn nursery team who made implementation of this project possible.

Author information

Authors and Affiliations

  1. University of South Alabama Children’s and Women’s Hospital, Mobile, AL, USA

    Kelechi Ikeri, Kristen Noles, Kalsang Dolma, Tracy Roth, Ashley Smithgall, Caitlin Skipper & Michael Zayek

Authors
  1. Kelechi Ikeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristen Noles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kalsang Dolma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tracy Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashley Smithgall
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caitlin Skipper
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Zayek
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KI conceptualized and designed the initiative, participated in the development and implementation of all phases of the PDSA cycles, managed data, led the statistical analysis developed the control charts and figures, drafted the initial manuscript and reviewed and revised the final manuscript; KN conceptualized and designed the initiative, participated in the development and implementation of all phases of the PDSA cycles, managed data, and reviewed the final manuscript; KD designed the initiative from the earliest stages, participated in the development and implementation of PDSA cycles, and reviewed the final manuscript; TR, AS and CS participated in the development and implementation of all phases of the PDSA cycles, and reviewed the final manuscript; MZ conceptualized and designed the initiative, participated in the development and implementation of all phases of the PDSA cycles contributed to the initial draft of the manuscript, managed data, developed the table, reviewed for critical intellectual content and revised the final manuscript.

Corresponding author

Correspondence to Kelechi Ikeri.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ikeri, K., Noles, K., Dolma, K. et al. Optimizing the hospital discharge process to facilitate family-centered care for well newborns. J Perinatol 43, 952–957 (2023). https://doi.org/10.1038/s41372-023-01703-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-023-01703-7

Search

Advanced search

Quick links