TOP 16 - Improving Early Discharge Boarding Time in the Pediatric Inpatient Unit- A Quality Improvement Project

Publication Number: 3744.TOP 16

Nur Islam, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Liseth Burbano Pinuela, SUNY Downstate, Brooklyn, NY, United States; Ratna B. Basak, Kings County hospital, Greenvale, NY, United States

Background: Discharge Boarding Time (DBT) is the interval between a physician's discharge order in the EMR and the patient's departure. Delays in pediatric discharges reduce bed availability, strain resources, disrupt workflow, and may contribute to perceived disparities in care. At Kings County Hospital, a safety-net facility in underserved Brooklyn, baseline data showed only 19% of discharges occurred before noon, with an average DBT of 2 hours.

Objective: To increase the percentage of pediatric discharges before 12 PM from a baseline of 19% to 36% (50 % increase from baseline) within six months.

Design/Methods: This quality improvement (QI) project used the Plan-Do-Study-Act (PDSA) framework to promote earlier pediatric discharges. Data were prospectively collected from December 2024 to July 2025. Pediatric patients identified as discharge-ready during daily multidisciplinary rounds were included. PDSA cycles addressed key contributors to delayed discharges through interventions such as early discharge identification, caregiver notification at least 12 hours prior, coordination with transportation and social work, and medication reconciliation by the night team. Monthly discharge rates before noon were analyzed descriptively to compare pre- and post-intervention trends.
PDSA Cycles:
Cycle 1 (Feb-Mar 2025): Education
Cycle 2 (Apr-May 2025): Education + Early Subspecialty Clearance
Cycle 3 (Jun-Aug 2025): Education + Early Subspecialty Clearance + Early Rounding

Results:
During the baseline period (Dec 2024-Feb 2025), the average early discharge rate was 25.2%, with no upward trend. Following interventions, rates improved-53.3% in April, 44.6% in May, 36.8% in June, 40% in July, and 47.3% in August-demonstrating sustained gains in discharge timeliness.

Discussion:
April's marked improvement highlights the importance of interdisciplinary coordination, early caregiver communication, and proactive planning. The temporary decline in July was likely due to new resident transitions, underscoring the need for consistent reinforcement. Sustained improvement through August indicates successful integration of interventions into routine workflow. Future PDSA cycles will emphasize early discharge scheduling and a standardized discharge checklist.

Conclusion:
Tailored interventions based on local needs and early stakeholder engagement proved effective in improving discharge efficiency. Early discharge rates remain above baseline, with 47.3% achieved in August 2025. Continued reinforcement and monitoring are essential to sustain progress. This ongoing QI initiative is expected to conclude in January 2026.

Summary of PDSA Cycles and intervention
Summary of sequential PDSA cycles focusing on eduction, early mulltidisciplinary observation, and reinforement to enhance early discharge readiness.

Run Chart of Discharges Before 12 PM
Run Chart demonstrating the percentage of pediatric inpatinets discharged before 12 PM over time. Each PDSA cycle reflects sequential interventions aimed at improving early discharge efficiency and boarding time reduction.