Theodore Kouo1,2, Keith Kleinman3,2, Hanae Fujii-Rios4, Oluwakemi Badaki-Makun3,2, Julia Kim3,5, Lucas Falco6, Therese L Canares3,2. 1. Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland; tkouo1@jhmi.edu. 2. Divisions of Pediatric Emergency Medicine and. 3. Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 4. Department of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and. 5. General Pediatrics and Adolescent Medicine. 6. Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, Arizona.
Abstract
BACKGROUND: Pediatric emergency department (PED) overcrowding and prolonged boarding times (admission order to PED departure) decrease quality of care. Timely transfer of patients from the PED to inpatient units is a key driver that relieves overcrowding. In 2015, PED boarding time at our hospital was 10% longer than the national benchmark. We described a resident-led quality-improvement initiative to decrease PED mean boarding times by 10% (from 173 to 156 minutes) within 6 months among general pediatric admissions. METHODS: We applied Plan-Do-Study-Act (PDSA) methodology. PDSA 1 (October 2016) interventions were bundled to include streamlined mobile communications, biweekly educational presentations, and reminder signs. PDSA 2 (August 2017) provided alternative workflows for senior residents. Outcomes were mean PED boarding times for general pediatrics admissions. The proportion of PICU transfers within 12 hours of admission served as a balancing measure. Statistical process control charts were used to analyze boarding times and PICU transfer rates. RESULTS: Leading up to PDSA 1, monthly mean boarding times decreased from 173 to 145 minutes and were sustained throughout the study period and up to 1 year after study completion. The X-bar chart demonstrated a shift with 57 consecutive months of mean boarding times below the preintervention mean. There were no changes in PICU transfer rates within 12 hours of admission. CONCULSIONS: Resident-led quality improvement efforts, including education and streamlined workflow, significantly improved PED boarding time without causing harm to patients.
BACKGROUND: Pediatric emergency department (PED) overcrowding and prolonged boarding times (admission order to PED departure) decrease quality of care. Timely transfer of patients from the PED to inpatient units is a key driver that relieves overcrowding. In 2015, PED boarding time at our hospital was 10% longer than the national benchmark. We described a resident-led quality-improvement initiative to decrease PED mean boarding times by 10% (from 173 to 156 minutes) within 6 months among general pediatric admissions. METHODS: We applied Plan-Do-Study-Act (PDSA) methodology. PDSA 1 (October 2016) interventions were bundled to include streamlined mobile communications, biweekly educational presentations, and reminder signs. PDSA 2 (August 2017) provided alternative workflows for senior residents. Outcomes were mean PED boarding times for general pediatrics admissions. The proportion of PICU transfers within 12 hours of admission served as a balancing measure. Statistical process control charts were used to analyze boarding times and PICU transfer rates. RESULTS: Leading up to PDSA 1, monthly mean boarding times decreased from 173 to 145 minutes and were sustained throughout the study period and up to 1 year after study completion. The X-bar chart demonstrated a shift with 57 consecutive months of mean boarding times below the preintervention mean. There were no changes in PICU transfer rates within 12 hours of admission. CONCULSIONS: Resident-led quality improvement efforts, including education and streamlined workflow, significantly improved PED boarding time without causing harm to patients.
Authors: Robert W Turer; Miguel Arribas; Sarah M Balgord; Stephanie Brooks; Laura R Hopson; Benjamin S Bassin; Richard Medlin Journal: AEM Educ Train Date: 2020-09-14
Authors: Kathryn M Lemberg; Danielle W Koontz; David J Young; P Galen DiDomizio; Anne King; Allen R Chen; Christopher J Gamper; Elizabeth Colantuoni; Aaron M Milstone; Stacy L Cooper Journal: Pediatr Qual Saf Date: 2022-03-30