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Improving paediatric flow in an UK Paediatric Assessment Unit
Danning Li1, Movin Abeywickrema2, Sharvari Vadeyar2
1Department of Paediatrics, Birmingham Heartlands Hospital, Birmingham, UK danning.li@nhs.net.
BMJ Open Quality
|January 28, 2022
Summary
Implementing new guidelines significantly improved timely patient reviews in pediatric services. Adequate registrar staffing is crucial for efficient patient discharge and managing acute pediatric care.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Patient Flow Management
Background:
- The Royal College of Paediatrics and Child Health (RCPCH) established guidelines in 2010 for acute pediatric services, specifying timeframes for senior medical reviews.
- These standards include registrar (tier two doctor) review within 4 hours and consultant review within 14 hours for pediatric medical admissions in the UK.
- Optimizing patient flow and adherence to these critical review times are essential for effective acute pediatric care.
Purpose of the Study:
- To implement RCPCH guidelines for timely senior reviews in acute pediatric admissions.
- To measure the impact of quality improvement interventions on patient flow and adherence to review timeframes.
- To identify key factors influencing efficient patient management and discharge in pediatric services.
Main Methods:
- Four cycles of quality improvement interventions were conducted between March 2018 and March 2020, involving 288 patient datasets.
- Interventions included extending consultant availability, prioritizing patients awaiting consultant review during handover, and optimizing registrar (tier two doctor) rostering.
- Data analysis focused on the proportion of patients receiving timely registrar and consultant reviews and factors affecting patient discharge.
Main Results:
- Following interventions, the proportion of patients seen by a consultant within 14 hours improved from 53.3% to 95% (p=0.005).
- Timely registrar review (within 4 hours) increased from 82.9% to 96.2% (p=0.028) with improved registrar staffing.
- A significant majority (65.6%) of pediatric patients were managed and discharged by registrars, with more registrars on shift correlating with shorter discharge times (R=-0.587).
Conclusions:
- Quality improvement initiatives successfully enhanced adherence to RCPCH timeframes for senior reviews in acute pediatric services.
- Adequate registrar (tier two doctor) staffing is a critical factor for prompt patient review and efficient discharge.
- Future research should explore nursing rostering, bed management, and the influence of external factors like COVID-19 on pediatric patient flow.
Keywords:
continuous quality improvementefficiencylength of stayorganizationalpaediatricspatient dischargeMore Related Videos
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