IDEA: Improved Discharge Experience for All Project. Investigating the effect of a bundle of educational, process change and cultural interventions to optimise the paediatric hospital discharge summary processes.

The IDEA research project looked at a number of strategies for embedded hypothetical questions and outcomes regarding a number of improvements in discharge processes. A bundle of educational, process change and cultural interventions to improve the discharge summary processes. An eight point intervention bundle includes 1) Education package 2) Cultural change 3) Process change 4) Pharmacy involvement 5) Discharge summaries were used as an educational tool for parents 6) Discharge summary champions 7) Mnemonic IDEA and 8) Positive reinforcement and daily reminders. INTERVENTION DURATION: The intervention was implemented initially for 3 months period and then outcomes will be assessed at 3 months and then at 12 and 24 months (with discharge summary completion rates). Who will deliver intervention: The intervention (effective and timely discharge summaries using the intervention bundle to improve timely discharge summaries) is provided by registrars and residents. Location: At Queensland Children’s Hospital (Quaternary children’s Hospital) Monitoring: A phone application will be used to log in all patients getting timely discharge summaries in the intervention arm. PHONE APPLICATION: A customized phone application has been created to log all the patients in the study and their discharge completions. This application is only for study purposes to log in how many patients get the discharge summary at discharge. The application is part of the study process and will not be accessible to the patients. EDUCATIONAL PACKAGE: includes education regarding how to make effective discharge summaries. We designed an “educational video” and a “power point presentation” specifically for this study. “The educational video instructs the registrars and residents how to use discharge summaries to educate the parents at discharge.” All registrars are signed off after training (in intervention) by the principal investigator prior to their work initiation in the intervention teams. Further ongoing education regarding study intervention including making timely discharge summaries and improving discharge summary quality using a standardized power point presentation is provided weekly (20 minutes) to all the junior doctors who rotate through the intervention team. CULTURAL CHANGE: There is a focus on cultural change with discharge summary considered an integral part of the patient separation. The discharge summary is considered as the responsibility of entire clinical team rather than the most junior member of the staff. There is involvement of consultants and fellows in discharge summary process. PROCESS CHANGE: The electronic discharge summaries (EDS) are started as early as possible in the admission to reduce the memory recall issues. The EDS are aimed to be nearly completed on the day prior to discharge using the discharge plans from the last ward rounds. The existing processes for the discharge summaries including the discharge summary incentives i.e. weekly rewards for the best performing team are not changed. PHARMACY INVOLVEMENT: The pharmacy was involved in entering the current medications of complex patients at discharge in the discharge summary. DISCHARGE SUMMARIES AS AN EDUCATIONAL TOOL: An important intervention included use of the Discharge summaries as an educational tool for the parents at discharge. DISCHARGE SUMMARY CHAMPIONS: Certain clinical staff members were designated as Discharge summary champions who were provided face to face orientation to the study interventions (in a two hours face to face workshop) two weeks prior to the study implementation. Discharge summary champion role included reminding and encouraging the timely discharge summary process with the registrars and residents making discharge summaries. MNEMONIC IDEA: was used to remind the intervention teams about the interventions. “I “= Initiate the discharge summary early. “D” = Doctor details e.g. GP details to be confirmed. “E” = Expected Date and time of Discharge “A”= Aftercare including patient education and the follow up appointments DISCHARGE SUMMARY AUDIT TOOL: A discharge summary audit tool will be developed to assess the quality of discharge summaries. The tool is only for evaluating the quality of discharge summary for research purposes. The discharge summaries will be audited by staff who will not be involved in providing clinical care or making the discharge summary for these patients. The tool will be published as a supplement in a research publication and can be made available on request. The audit feedback will be provided to staff following the completion of the study. A focus group discussion will be conducted to evaluate the effectiveness of the interventions at the completion of the study.