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How Do We Improve Discharge From the Pediatric Emergency Department?

October 12, 2022

Editor’s Note: Dr. Morgan Irwin-Weyant is a pediatric resident. She plans to pursue a career in pediatric emergency medicine.
-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

Once the evaluation of a patient is complete and no emergent cause or inpatient admission need is identified, how do we safely discharge patients from the emergency department (ED)? How do we ensure that patients, families, and the medical team all feel comfortable with discharge, which includes a clear follow-up plan and instructions for when to return to the ED? Pediatric EDs are busy locations, with a large number of moving parts, which makes them prone to lapses in communication and  a potential setup for errors.

Dr. Niloufar Paydar-Darian and colleagues from Boston Children’s Hospital and Texas Children’s Hospital, in a Quality Report being early released this week in Pediatrics, share the results of a standardized discharge process implemented in the pediatric ED at Boston Children’s Hospital (10.1542/peds.2021-054307). To facilitate multidisciplinary care coordination, reconciliation of testing and treatment, plan for care at home, and team engagement, the authors created a paper discharge checklist, requiring a nursing and MD review huddle before a patient would be qualified for discharge, emphasis on discharge vital signs, and scripted discharge instructions.

The team had positive outcomes with the paper checklist, with 94% completion of the new checklist and an increase in obtaining and documenting vital sign within 60 minutes of discharge from 61% to 83% over the course of the study period. They also saw a decrease in serious safety events and an increase in length of time between preventable low-level events. Importantly, this new discharge process did not add to total length of stay, which is a priority in a place where time is crucial. However, the Press Ganey patient satisfaction scores related to the quality of discharge information remained the same.

This study provides a framework for standardizing the whole discharge process from the ED, which can continue to be built upon and adapted to fit individual institutions in order to address this important transition of care. Take a look at this article to see what elements may be helpful to bolster your own ED’s discharge procedures.

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