PURPOSE OF STUDY: Discharge of hospitalised paediatric patients may be delayed for various reasons after patients have otherwise met discharge goals. Such delays contribute to long emergency department (ED) wait times, cancelled elective surgical cases, and denied transfers from outside facilities. We sought to test an iterative quality improvement process to identify and address barriers to discharge, with the aim of improving discharge efficiency for our hospitalised paediatric patients. METHODS USED: We used value stream mapping to map the current paediatric ward discharge process and identify areas for improvement in efficiency. The most common cause for discharge delays was lack of transportation (29%, n=16), followed by prescription delays (27%, n=15). Root cause analysis revealed opportunities for improvement, which included altered physician workflow, a standardised discharge checklist during daily discharge rounds to identify potential discharge needs, and a resident note template that records potential discharge needs during the admission process. Primary outcomes are percentage of discharges before noon, percentage of discharges with discharge orders before 10 am, and length of stay index. Balancing measures include readmission rate, ED revisit rate, ED boarding times, and patient experience survey scores. Outcome measures were tracked using run charts, then analysed using statistical process control at the end of the study period. SUMMARY OF RESULTS: In the first 8 months of interventions, percentage of discharges before noon has increased from the baseline average of 14% to an average of 25%. Percentage of patients with discharge orders before 10 am increased from the baseline average of 14% to 28%. Length of stay index, readmission rate, ED revisit rate, average ED boarding time, and patient experience survey scores remained stable over the study period. CONCLUSIONS: We conclude that this iterative quality improvement process involving implementation of a discharge bundle is effective in improving paediatric discharge efficiency without affecting subsequent hospital utilisation or patient experience.