153 - Geographic cohorting of Pediatric Hospital Medicine patients results in a higher percentage of early discharges

Poster Number: 153
Publication Number: 153.1241

Background: Geographic cohorting refers to the clustering of medical services’ hospital admissions to defined hospital units with the potential to streamline the multidisciplinary teams (e.g., physicians, nurses, care managers and social workers) caring for a group of patients. At our institution, patients admitted to the Pediatric Hospital Medicine (PHM) service are assigned sequentially to one of five teams. These patients under the care of PHM account for approximately 35% of children admitted to acute care units and were not previously included in cohorting efforts. In response to a sustained census surge from 2022-2023, geographic cohorting of these patients was one facet of our hospital’s capacity management plan to optimize discharge efficiency without requiring additional staffing. The impact of geographic cohorting on discharge time is unknown.

Objective: We aimed to: 1) geographically cohort at least 60% of patients cared for by PHM to their team’s primary and secondary acute care units and 2) compare the PHM division’s discharge time before and after this intervention.

Design/Methods: This project took place at a 317-bed, tertiary-care, academic children’s hospital. We prospectively monitored the percentage of patients on all five PHM teams who were admitted to their pre-defined primary and secondary units over a 4-month period from May 2023 to August 2023. Then, we retrospectively compared all patients discharged from the PHM service in this four-month span to a similar four-month span from May 2022 to August 2022. The primary outcome was percentage of patients discharged before 11AM.

Results: During the prospective observation period, 78.2% of patients admitted under the PHM division were placed on either their assigned primary or secondary unit. The mean daily PHM census during the four-month 2022 period was similar compared to the four-month 2023 period (51.8 and 52.2 patients, p=0.707). Using chi-square statistical analysis, we found a significant increase in the percentage of patients discharged before 11AM after the cohorting intervention (21.7% versus 27.6%, p< 0.00001). While the division’s median length of stay increased after the intervention (1.54 [IQR 1.73] days in 2022 versus 1.6 [IQR 1.87] days in 2023; p=0.02), it is worth noting that patient complexity also increased with a case mix index of 1.44 in the 2022 span versus 1.54 in the 2023 span.

Conclusion(s): Geographic cohorting was associated with an increase in earlier discharge times when comparing groups with similar census and similar timing within the academic calendar year.