Non-Medical Readiness in Pediatric Bone Marrow Transplant: Improving the Discharge Process Using a Multidisciplinary Team Approach

Topic Significance & Study Purpose/Background/Rationale 

Pediatric patients who have undergone bone marrow transplant (BMT) are not consistently prepared (non-medical readiness) for hospital discharge at the same time they meet physiologic criteria (medical readiness). Several factors contribute to an inadequate discharge, including time constraints for education focused on complex care needs/medication management, and communication challenges among the multidisciplinary team.  To improve the discharge process and increase preparedness in young BMT patients, a multidisciplinary team was created to conduct a quality improvement (QI) project.

The aim of the project was to increase the percentage of BMT patients who are prepared for discharge by standardizing the time sequence of essential nonmedical/educational discharge process tasks prior to meeting criteria medical readiness.

Methods, Intervention, & Analysis 

“Lean”, a QI strategy focused on customers and what they value, was implemented to collect baseline data describing key process measures, and to address gaps through “Plan-Do-Study-Act” cycles.

Data from a chart review across a subset BMT patients and a staff survey supported that pediatric BMT patients had a high degree of non-medical readiness.

Team members created standard assessment tools and education plans and scheduled these activities to decrease the last minute rush at time of discharge.  Weekly team meetings and real-time audits allowed for individualization the process to each patient’s status, enabling the team to stay on schedule.  Completed tasks were categorized according to the scheduled time sequence and were reviewed for timeliness and completion. Every three months a quarterly report was shared with staff.

Findings & Interpretation

In the first quarter of 2014, 17% of patients met criteria for discharge preparedness and by second quarter, 30% met criteria.  As real-time audits reveal tasks that that fall out of the scheduled time, the process is refined to improve its efficiency.

Discussion & Implications

The percentage of discharge preparedness in young BMT patients continues to rise.  The discharge process is continually refined and improved each quarter. In the future, the process will include follow-up with patients/families to assess their ability to care for the child outpatient.