Criteria-led discharge in paediatric inpatient care in Switzerland: a quality improvement study of implementation, safety and satisfaction

Paediatric hospitals have high admission rates and short lengths of stay, leading to a high turnover. The discharge process is challenged by delays and a lack of standardisation. Criteria-led discharge (CLD) has been proposed to overcome these challenges. CLD enables nursing staff to safely discharge patients once predefined clinical criteria are met, reducing reliance on physician review and minimising delays. We introduced CLD on a paediatric ward and evaluated its implementation in a quality improvement study pre- (December 2023-March 2024) and post-implementation (December 2024-March 2025). Outcomes were assessed using retrospective electronic health record data and surveys. The primary outcome was patient safety, measured by 14-day readmission and complication rates. Secondary outcomes included efficiency and patient flow, measured by length of stay, time of day at discharge and discharge delays, as well as patient, caregiver and staff satisfaction. A total of 355 eligible admissions (202 pre-, 153 post-implementation) were included into the analysis in three diagnostic groups: 122 bronchiolitis, 135 pneumonia and 98 asthma. 14-day readmission rates were comparable between CLD (3.2%), standard discharge (SD) (3.4%) and post-implementation SD (4.5%) cohorts. Patient, caregiver and staff satisfaction was high. CONCLUSIONS: CLD is non-inferior in terms of safety compared to standard discharge. It subjectively improved discharge efficiency and positively impacted workload distribution while maintaining high patient, caregiver and staff satisfaction. CLD is a promising tool to facilitate discharges in paediatrics. Local adaptation and quality control are necessary for successful implementation. WHAT IS KNOWN: • Criteria-led discharge (CLD) increases standardisation, safety and efficiency in discharges from hospital. WHAT IS NEW: • CLD is a safe method to discharge children from inpatient paediatric wards. • CLD may decrease stress of ward staff and enhance efficiency in paediatric hospitals.