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Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department
PURPOSE: Visits to pediatric emergency departments (EDs) are increasing, leading to overcrowding, prolonged patient wait times, and negative patient experiences. In our system, these prolonged wait times and negative experiences notably impact mid-acuity patients. As such, we sought to decrease thei...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297400/ https://www.ncbi.nlm.nih.gov/pubmed/32656469 http://dx.doi.org/10.1097/pq9.0000000000000302 |
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author | Payne, Asha S. Brown, Kathleen M. Berkowitz, Deena Pettinichi, Jeanne Schultz, Theresa Ryan Thomas, Anthony Chamberlain, James M. Morrison, Sephora N. |
author_facet | Payne, Asha S. Brown, Kathleen M. Berkowitz, Deena Pettinichi, Jeanne Schultz, Theresa Ryan Thomas, Anthony Chamberlain, James M. Morrison, Sephora N. |
author_sort | Payne, Asha S. |
collection | PubMed |
description | PURPOSE: Visits to pediatric emergency departments (EDs) are increasing, leading to overcrowding, prolonged patient wait times, and negative patient experiences. In our system, these prolonged wait times and negative experiences notably impact mid-acuity patients. As such, we sought to decrease their time-to-first-provider from 92 to 60 minutes. METHODS: After identifying inefficiencies in patient arrival, triage, and assessment, we redesigned our physical space and implemented a new triage process. Further, we deployed a new multidisciplinary front-end team consisting of a physician, nurses, and ED tech specialists to create and implement an initial management plan. Time-to-first-provider for mid-acuity patients was the main outcome measure. We examined ED length of stay (LOS) as a balancing measure. Post hoc, we measured time-to-first-nursing assessment and the proportion of high-acuity patients seen within 20 minutes as additional measures of the impact of these interventions on our system. All analyses were measured using statistical process control charts. RESULTS: During high patient volumes, we decreased the time-to-first-provider to 70 minutes, but exceeded our goal during low patient volumes (41 minutes). We observed a 5% decrease in LOS during both high and low patient volumes (5% and 8%, respectively). There was a 60% increase in the time-to-first-nursing assessment. CONCLUSIONS: A new front-end process resulted in improved time-to-first-provider and LOS. The new process was associated with longer times for nursing assessments but did not negatively impact the rapid physician assessment of higher acuity patients. |
format | Online Article Text |
id | pubmed-7297400 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-72974002020-07-09 Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department Payne, Asha S. Brown, Kathleen M. Berkowitz, Deena Pettinichi, Jeanne Schultz, Theresa Ryan Thomas, Anthony Chamberlain, James M. Morrison, Sephora N. Pediatr Qual Saf Individual QI Projects from Single Institutions PURPOSE: Visits to pediatric emergency departments (EDs) are increasing, leading to overcrowding, prolonged patient wait times, and negative patient experiences. In our system, these prolonged wait times and negative experiences notably impact mid-acuity patients. As such, we sought to decrease their time-to-first-provider from 92 to 60 minutes. METHODS: After identifying inefficiencies in patient arrival, triage, and assessment, we redesigned our physical space and implemented a new triage process. Further, we deployed a new multidisciplinary front-end team consisting of a physician, nurses, and ED tech specialists to create and implement an initial management plan. Time-to-first-provider for mid-acuity patients was the main outcome measure. We examined ED length of stay (LOS) as a balancing measure. Post hoc, we measured time-to-first-nursing assessment and the proportion of high-acuity patients seen within 20 minutes as additional measures of the impact of these interventions on our system. All analyses were measured using statistical process control charts. RESULTS: During high patient volumes, we decreased the time-to-first-provider to 70 minutes, but exceeded our goal during low patient volumes (41 minutes). We observed a 5% decrease in LOS during both high and low patient volumes (5% and 8%, respectively). There was a 60% increase in the time-to-first-nursing assessment. CONCLUSIONS: A new front-end process resulted in improved time-to-first-provider and LOS. The new process was associated with longer times for nursing assessments but did not negatively impact the rapid physician assessment of higher acuity patients. Wolters Kluwer Health 2020-05-26 /pmc/articles/PMC7297400/ /pubmed/32656469 http://dx.doi.org/10.1097/pq9.0000000000000302 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Individual QI Projects from Single Institutions Payne, Asha S. Brown, Kathleen M. Berkowitz, Deena Pettinichi, Jeanne Schultz, Theresa Ryan Thomas, Anthony Chamberlain, James M. Morrison, Sephora N. Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department |
title | Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department |
title_full | Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department |
title_fullStr | Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department |
title_full_unstemmed | Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department |
title_short | Improving Throughput for Mid-acuity Patients in the Pediatric Emergency Department |
title_sort | improving throughput for mid-acuity patients in the pediatric emergency department |
topic | Individual QI Projects from Single Institutions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297400/ https://www.ncbi.nlm.nih.gov/pubmed/32656469 http://dx.doi.org/10.1097/pq9.0000000000000302 |
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