Baby Steps to Discharge

Methodist Children’s Hospital (San Antonio, Texas)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Added to Collection

Project Topic

Improving the discharge process

Hospital Unit

Neonatal Intensive Care Unit (NICU)

CSI Participants

Nikki Davidson, MSN, RN, CNL
Christina Potts, BSN, RN
Arlene Rieger, BSN, RN, CCRN
Bethany Roberts, BSN, RN

Project Goals/Objectives

  1. To increase electronic charting compliance 30 percent
  2. To decrease average length of stay one day
  3. To decrease RN incremental overtime 10 percent

Project Outcomes

  1. Increased charting compliance for our three indicators: Hepatitis B (46 percent), CCHD (29 percent) and PKU (3 percent)
  2. Decreased average length of stay one day
  3. Decreased incremental overtime by 58 percent
  4. These outcomes resulted in an estimated annual fiscal impact of $8,663,763.

Project Overview

The discharge process in the NICU is complex, often requiring complicated caregiver teaching and coordination of follow-up care and medical resources. Unfortunately, our internal discharge process was unorganized and a source of frustration for families, nurses and care providers.

The problem was a lack of uniformity in documentation and poor electronic health record (EHR) charting compliance among bedside nurses. Shortly after beginning our project, we discovered the reason for poor charting compliance: although nurses were charting in the EHR, they were not always charting in the proper place.

With this in mind, we created a developmental milestone-based tool to monitor and track discharge progress. We based the tool on our specific unit policies, and from there collected feedback from nurses on suggested improvements. “Baby Steps to Discharge” is a communication and accountability tool designed for use during nurse-to-nurse handoffs and for providers to track which infants are prepared for discharge as well as which milestones might be accomplished during their shift.

Overall, creating and launching “Baby Steps to Discharge” has been an extremely positive experience for our unit. Nurses and providers use the tool daily and it has become a part of our unit culture more quickly than we could have imagined. It has immensely improved the organization of discharge milestones and EHR charting compliance, increasing satisfaction with the discharge process and decreasing incremental overtime. Our unit nurses reported more perceived time to perform caregiver education prior to the discharge process, and facility physicians presented the tool at their “Transitions of Care” conference.

We plan to continue learning from our process and tweaking the tool as needed to meet our unit’s needs. Additionally, our unit practice council plans to continue with chart audits to ensure proper EHR charting compliance.

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The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.