Using an electronic discharge process to improve patient experience and timeliness in a pediatric urgent care setting.

BACKGROUND: Most patients in acute care settings are discharged home. Time waiting for discharge paperwork does not add value to patient experience. Quality discharge counseling is critical for patient experience and safety. OBJECTIVE: To increase online portal enrollment in order to decrease length of stay through use of an electronic discharge (e-discharge) process. PATIENT INVOLVEMENT: We used patient tracers to evaluate the perception of the UC discharge process at baseline, which helped identify barriers to signing up for the patient portal. METHODS: We performed a manual audit of patient encounters twice a month (N = 1431) to determine rate of portal enrollment, e-discharge, and LOS. We calculated summary distributions of LOS for those that received hardcopy vs. e-discharge instructions. We measured the percentage of positive scores for overall experience and quality of anticipatory guidance for all completed surveys. RESULTS: For audited encounters portal enrollment increased from 22% to 37% (p < 0.001). Encounters with e-discharge instructions had a shorter median LOS compared to patient encounters that received hardcopy instructions (55.0 vs. 68.0 min; p < 0.001). There was no difference in overall rating or perceived quality of anticipatory guidance between groups. DISCUSSION: Patients who received e-discharge instructions had significantly shorter LOS compared to those who received hardcopy instructions. The overall rating and perceived quality of anticipatory guidance were not negatively affected by e-discharge instructions. PRACTICAL VALUE: Enrolling children into an online portal requires additional steps to ensure that only patients and their legal guardians have access to protected patient information. However, the benefits of offering the portal include shorter LOS without impacting the perceived quality of discharge counseling. FUNDING: Children's Mercy supported all phases of this study.

Length of Stay for Patients With Limited English Proficiency in Pediatric Urgent Care.

This retrospective chart review compared the length of stay (LOS) of families with limited English proficiency (LEP) versus English-speaking families seen in 3 pediatric urgent care centers (PUCCs). Visits were included for patients aged 2 months to 17 years seen between January 1, 2016, and December 31, 2016, with 1 of 5 primary diagnoses. For each LEP encounter, we randomly selected 3 English-speaking encounters within the same PUCC and diagnosis class. We compared overall LOS between LEP and English-speaking encounters. Of our entire sample, 184 (1.03%) were LEP encounters, of which 145 (78.8%) preferred Spanish. Comparing the LEP visits to 552 matched English-speaking visits, we found a significant difference in average LOS (LEP 85.5 minutes; English-speaking 76.4 minutes) and in prescriptions provided (P = .005) but not in triaged acuity nor number of medications administered, laboratory or radiological studies, or suction treatments. This study serves as a starting point to better care for patients/families with LEP in PUCCs.

Universal Adolescent Suicide Screening in a Pediatric Urgent Care Center.

The aim of this article is to describe the implementation of a 2-question suicide screening tool in a pediatric urgent care center to identify patients at risk of suicide. Adolescents presenting during a 12-month period completed the screening tool. Positive response to either question triggered further social work evaluation, including a Columbia-Suicide Severity Rating Scale (C-SSRS). Of 4,786 patients screened, 95 (2%) responded positively. Of these, 75 (79%) also had a positive C-SSRS. Only 7 (7%) had chief complaints related to mental health. A group of 78 patients (82%) were discharged with outpatient mental health referral, and 10 (10%) were admitted to a psychiatric facility. Universal adolescent suicide screening in an acute care setting did not significantly affect flow in our pediatric urgent care and was able to detect patients at risk of suicide, especially those with chief complaints unrelated to mental health.