We have a 24-hour hospital. What could we do to improve our 24-hour service to patients and families without using additional resources?”

This was the broad question that pediatrician Akshata Hopkins and the rest of the 24-Hour Care Progression Team at Johns Hopkins All Children’s Hospital considered. Composed of nurses, case managers and social workers, as well as physicians and residents, the team wanted to expand rounding and discharge hours to better serve working families. It also wanted to reduce the time between discharge order entry and actual discharge.

The team’s combined efforts led to a 30 percent reduction in that metric and nearly a 30 percent drop in length of stay.

“We will discharge a child at 1 a.m. if that child is ready to go home, and this can make a real difference in terms of cost and convenience for families—it may mean one fewer day of work missed for a parent,” says Hopkins.

Discharge planning is now an active part of daily care, she says. Residents round in the evenings at bedside so that working parents are involved in care.

“Expanding discharge hours and other initiatives have increased access and throughput, and I’m looking now at the impact on the bottom line,” says Hopkins. “But the real value is how much our patients and families appreciate getting home as early as they safely can. It’s just the right thing for the patient.”

The team’s work was recognized with a 2016 Johns Hopkins Medicine Clinical Award for Clinicians and Care Teams in Innovations in Clinical Care. Of the award, Hopkins says: “It is a big honor for the group, and it really was a group effort: Nursing, social work and residents took ownership of the changes we needed to make. We were all passionate, we were all determined and we all wanted to be leaders of change.”