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Improving the Safety of Pediatric Emergency Department to Inpatient Transfers of Care
Zoe Grabinski1,2, Ellen Duncan1,2, Kavita Patel1,2
1Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.
Insights
Implementing risk stratification and interdisciplinary huddles in pediatric emergency departments significantly reduced advanced respiratory interventions and intensive care unit transfers for high-risk patients. This improves patient safety during care transitions.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Patient Safety Research
Background:
- Transitions of care, particularly from the emergency department (ED) to inpatient settings, pose significant patient safety risks.
- Vulnerabilities are heightened for pediatric patients with respiratory conditions requiring oxygen.
- A structured approach to identify high-risk patients and facilitate interdisciplinary communication can improve outcomes.
Purpose of the Study:
- To implement and evaluate a quality improvement initiative to reduce adverse events in high-risk pediatric respiratory patients during ED-to-inpatient transitions.
- To assess the impact of risk stratification, electronic health record (EHR) visualization, and interdisciplinary huddles on patient outcomes.
Main Methods:
- A quality improvement initiative was conducted in a tertiary-care, academic pediatric ED.
- High-risk patients were identified using respiratory status and oxygen requirement.
- Digital mapping via EHR track-board icons visualized high-risk patients.
- Interdisciplinary bedside huddles were implemented prior to patient transport.
- Outcome measures included escalations to advanced respiratory support, PICU upgrades, and RRS activations within 24 hours.
Main Results:
- Huddles were completed for 80% of identified high-risk respiratory patients.
- A significant reduction was observed: 53.1% fewer advanced respiratory interventions.
- PICU upgrades decreased by 57.8%, and RRS activations decreased by 59.8%.
- No significant change in the time from bed assignment to ED departure was noted.
Conclusions:
- Risk stratification, EHR visualization, and interdisciplinary huddles effectively improved outcomes for pediatric patients transitioning from the ED.
- This initiative enhances patient safety beyond the ED, positively impacting hospital resources.
- The findings demonstrate a successful strategy for mitigating risks during critical care transitions.
Background:
Transitions of care are a leading threat to patient safety. Vulnerabilities are intensified in emergency department (ED)-to-inpatient settings. A structure to identify and visualize high-risk patients, coupled with a process for interdisciplinary huddle prior to transport, can improve patient outcomes.
Methods:
We conducted a quality improvement initiative within a tertiary-care, academic, pediatric ED. Children with respiratory disease requiring oxygen were identified to be high risk for decompensation. Digital mapping of patient data was established for clinician visibility of high-risk patients using a track-board icon in the electronic health record (EHR). We implemented interdisciplinary bedside huddles prior to ED departure. Outcome measures included escalations to advanced respiratory support (ie, noninvasive positive pressure ventilation or intubation), pediatric intensive care unit (PICU) upgrades, or rapid response systems (RRS) activations within 24 hours. Our process measure was proportion of patients with huddle completion. Our balancing measure was time from bed assignment to ED departure. Statistical process control charts were used to analyze temporal changes.
Results:
Huddles were performed on 80% of high-risk respiratory patients. We observed a 53.1% reduction in advanced respiratory interventions, a 57.8% reduction in PICU upgrades, and a 59.8% reduction in RRS activations. There was no change in time from bed assignment to ED departure.
Conclusions:
Through risk stratification, EHR visualizations, and interdisciplinary huddles, we achieved improved outcomes for pediatric patients. This initiative mitigates risk beyond ED care, with significant implications on hospital resources and patient safety.
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