PD53-07 ANALYZING PATIENT-SPECIFIC FACTORS CONTRIBUTING TO EXTENDED PACU LENGTH OF STAY AND SUBSEQUENT COST: A QUALITY IMPROVEMENT INITIATIVE

232 Background: In a retrospective analysis at the Medical College of Wisconsin’s Cancer Center, we identified longer inpatient length of stay (LOS) for patients residing in low-socioeconomic (SES) ZIP Codes in Milwaukee County compared to their high-SES counterparts in 2020 (7.3 days compared to 7.1 days). Under the auspices of American Society of Clinical Oncology’ Quality Training Program (QTP) initiative, this study examined specific factors related to prolonged LOS for solid tumor oncology patients. Methods: This analysis includes initial CY20 LOS medical record data for select patient service areas. Supplemental data includes disease registry data, diagnostic data, and SES data determined by patient ZIP Code. We identified patients 18 years and older with a diagnosis of common oncologic malignancies from 1/1/2020-12/31/2020 (breast, gastrointestinal (GI), genitourinary (GU), gynecologic (GYN), head and neck (H&N), and lung cancers). Poisson regression models with robust standard errors were used to compare the LOS index (LOSi) between groups of patients based on race, SES group, primary payer, and BMI. Results: A total of 1,637 patients with solid tumor diagnosis admitted to hematology and oncology units were identified. The LOSi did not vary significantly by race (range 0.95 – 1.07, p = 0.40) or primary payer (range 0.99 – 1.04, p = 0.59), but lower SES groups tended to have longer LOSi, with LOSi ratio above 1 compared to high SES (low SES: 1.16, p = 0.2; medium-low SES: 1.24, p = 0.06). Among patients with breast cancer diagnosis, Black (LOSi = 1.24, p = 0.01), medium-low SES (LOSi = 1.46, p = 0.02), Medicaid (LOSi = 1.40, p = 0.00), underweight (LOSi = 1.66, p = 0.00), and overweight (LOSi = 1.23, p = 0.01) patients had slightly longer LOSi, with LOSi ratio above 1. Among patients with H&N cancer diagnosis, Black patients (LOSi = 0.77, p = 0.02) had slightly shorter LOSi, with LOSi ratio below 1. The LOSi did not vary significantly by other factors for patients with H&N cancer diagnosis or the other common oncologic malignancies evaluated. Conclusions: This study shows how patient-specific factors such as race, SES, primary payer, and BMI contribute to inpatient LOS. Healthcare systems may benefit by addressing patient-specific barriers and factors such as body mass index, SES and SDH, to reduce hospital LOS.

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A Quality Improvement Initiative to Increase the Number of Pediatric Resident Laceration Repairs

Journal of Graduate Medical Education ◽

10.4300/jgme-d-19-00331.1 ◽

2020 ◽

Vol 12 (1) ◽

pp. 51-57

Author(s):

Tracey L. Wagner ◽

Michael W. Dunn ◽

Maya S. Iyer ◽

Don Buckingham ◽

Sandra P. Spencer

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Tertiary Hospital ◽

Pediatric Emergency ◽

Quality Improvement Initiative ◽

Pediatric Resident ◽

Statistical Process ◽

Pediatric Residents ◽

Control Charting ◽

Clinical Procedures

ABSTRACT Background Pediatric residents must demonstrate competence in several clinical procedures prior to graduation, including simple laceration repair. However, residents may lack opportunities to perform laceration repairs during training, affecting their ability and confidence to perform this procedure. Objective We implemented a quality improvement initiative to increase the number of laceration repairs logged by pediatric residents from a baseline mean of 6.75 per month to more than 30 repairs logged monthly. Methods We followed the Institute for Healthcare Improvement's Model for Improvement with rapid plan-do-study-act cycles. From July 2016 to February 2018, we increased the number of procedure shifts and added an education module on performing laceration repairs for residents in a pediatric emergency department at a large tertiary hospital. We used statistical process control charting to document improvement. Our outcome measure was the number of laceration repairs documented in resident procedure logs. We followed the percentage of lacerations repairs completed by residents as a process measure and length of stay as a balancing measure. Results Following the interventions, logged laceration repairs initially increased from 6.75 to 22.75 per month for the residency program. After the number of procedure shifts decreased, logged repairs decreased to 13.40 per month and the percentage of lacerations repaired by residents also decreased. We noted an increased length of stay for patients whose lacerations were repaired by residents. Conclusions While our objective was not met, our quality improvement initiative resulted in more logged laceration repairs. The most effective intervention was dedicated procedure shifts.

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Using Quality Improvement Methodology to Increase Communication of Discharge Criteria on Rounds

Hospital Pediatrics ◽

10.1542/hpeds.2021-006127 ◽

2022 ◽

Author(s):

Katherine Christianson ◽

Alexandra Kalinowski ◽

Sarah Bauer ◽

Yitong Liu ◽

Lauren Titus ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Academic Medical Center ◽

Hospital Medicine ◽

Transitions Of Care ◽

Audit And Feedback ◽

Quality Improvement Initiative ◽

Readmission Rates ◽

The Impact ◽

Discharge Criteria

OBJECTIVE: Clear communication about discharge criteria with families and the interprofessional team is essential for efficient transitions of care. Our aim was to increase the percentage of pediatric hospital medicine patient- and family-centered rounds (PFCR) that included discharge criteria discussion from a baseline mean of 32% to 75% over 1 year. METHODS: We used the Model for Improvement to conduct a quality improvement initiative at a tertiary pediatric academic medical center. Interventions tested included (1) rationale sharing, (2) PFCR checklist modification, (3) electronic discharge SmartForms, (4) data audit and feedback and (5) discharge criteria standardization. The outcome measure was the percentage of observed PFCR with discharge criteria discussed. Process measure was the percentage of PHM patients with criteria documented. Balancing measures were rounds length, length of stay, and readmission rates. Statistical process control charts assessed the impact of interventions. RESULTS: We observed 700 PFCR (68 baseline PFCR from July to August 2019 and 632 intervention period PFCR from November 2019 to June 2021). At baseline, discharge was discussed during 32% of PFCR. After rationale sharing, checklist modification, and criteria standardization, this increased to 90%, indicating special cause variation. The improvement has been sustained for 10 months. At baseline, there was no centralized location to document discharge criteria. After development of the SmartForm, 21% of patients had criteria documented. After criteria standardization for common diagnoses, this increased to 71%. Rounds length, length of stay, and readmission rates remained unchanged. CONCLUSION: Using quality improvement methodology, we successfully increased verbal discussions of discharge criteria during PFCR without prolonging rounds length.

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