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A Resident-Led QI Initiative to Improve Pediatric Emergency Department Boarding Times
Theodore Kouo1,2, Keith Kleinman3,2, Hanae Fujii-Rios4
1Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland; tkouo1@jhmi.edu.
Insights
A resident-led quality improvement initiative successfully reduced pediatric emergency department (PED) boarding times. Streamlined communication and education improved patient flow without impacting intensive care unit transfers.
Area of Science:
- Healthcare Management
- Quality Improvement in Pediatrics
- Emergency Medicine Operations
Background:
- Pediatric emergency department (PED) overcrowding and extended boarding times negatively impact care quality.
- Efficient patient transfer from PED to inpatient units is crucial for mitigating overcrowding.
- The hospital's PED boarding time exceeded the national benchmark by 10% in 2015.
Purpose of the Study:
- To implement and evaluate a resident-led quality improvement initiative aimed at reducing PED mean boarding times.
- To decrease PED boarding times by 10% (from 173 to 156 minutes) within six months for general pediatric admissions.
- To assess the impact of interventions on patient flow and safety, using PICU transfer rates as a balancing measure.
Main Methods:
- Utilized Plan-Do-Study-Act (PDSA) methodology for iterative quality improvement.
- PDSA 1 involved bundled interventions: streamlined mobile communications, biweekly education, and reminder signs.
- PDSA 2 introduced alternative workflows for senior residents; statistical process control charts analyzed boarding times and PICU transfers.
Main Results:
- Monthly mean boarding times decreased from 173 to 145 minutes prior to PDSA 1 and remained sustained.
- Statistical process control charts indicated a significant shift, with 57 consecutive months of boarding times below the preintervention mean.
- No adverse impact observed on the proportion of PICU transfers within 12 hours of admission.
Conclusions:
- Resident-led quality improvement initiatives are effective in significantly reducing PED boarding times.
- Interventions focusing on education and workflow optimization can enhance patient flow in the PED.
- The implemented changes improved efficiency without compromising patient safety or care quality.
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.
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