TOP 11 - Decreasing Pediatric Inpatient Discharge Delays Due to Incomplete Consults

Publication Number: 3739.TOP 11

Monica Karas, University of Florida College of Medicine, Jacksonville, FL, United States; Taylor Millar, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, United States; Danielle A. Nese, University of Florida Jacksonville, Jacksonville, FL, United States; Firas Alqarajeh, UF Health Shands Children's Hospital, Jacksonville, FL, United States; Matthew Garber, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, United States

Background: In response to an increase in the number of late patient discharges, the hospitalist division was tasked with improving discharge efficiency on the 5th floor of our Children's hospital. Most patients on this unit are children with multisystem conditions, the majority of whom have a neurological condition. They are managed by the hospitalist team comprised of a hospitalist attending, a third-year pediatric resident, two first-year pediatric residents, medical students, and sometimes a family medicine first-year resident. The team consults sub-specialists as appropriate. We found that over 50% of late discharges (after 2PM) were due to delayed consultant recommendations (Figure 1). Therefore, the goal of this initiative's first phase is to decrease delayed discharges due to consultant communications.

Objective: The SMART aim of this project is to decrease the proportion of 5th floor late discharges occurring after 2PM due to delayed consultant communication by 50% by January 2026.

Design/Methods: This quality improvement initiative was granted IRB exemption.

Baseline and intervention data is obtained from an EPIC report identifying discharged patients who required consultation for care in the prior week. Data is collected from July through December 2025, and data collection and analysis will be completed by January 31, 2026.

Primary outcome measure: proportion of late discharges with consultations relative to all 5th floor discharges with consultations on the same day. Preliminary data is plotted on a control chart (Figure 2).

Process measures: proportion of consultants communicating to the primary team by 12PM, proportion of potential discharges with consultants alerted of the pending discharge by 8AM, and the proportion of patients with consultants noted on resident handoff.

Balancing measure: number of consultations per month in which the primary attending disagreed with its necessity, given less time to cancel the consultation in the intervention period.

Interventions (Figure 3): Indicate which consultants were contacted on the handoff; alert consultants of potential discharges by 8AM; ask consultants to publish their notes, meet with the team, or securely message the team on the hospital messaging service about their recommendations prior to 12PM.

Causes of Delayed Discharges
Overall reasons for late discharges after 2PM from July to September 2025

Late Discharges due to Consults Proportion Control Chart
Proportion of late discharges due to delayed consultant recommendations after 2PM from July to September 2025

QI Key Driver Chart
Key driver chart of QI project detailing aim, drivers and interventions