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Development and Implementation of a New Process to Improve Safety of Urgent Direct Admissions
Jessica Hart1,2, Elizabeth Kuhn1, Ellen Nord3
1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
A new urgent direct admission (UDA) process significantly increased UDA use and reduced intensive care unit (ICU) transfers within 12 hours. This streamlined approach enhanced patient safety and hospital efficiency.
Area of Science:
- Healthcare Management
- Patient Flow Optimization
- Quality Improvement in Pediatrics
Background:
- Direct admission strategies aim to alleviate emergency department congestion, enhance patient experience, and lower healthcare expenditures.
- Opportunities exist to standardize urgent direct admission (UDA) processes for improved safety and efficiency.
- A SMART (specific, measurable, achievable, relevant, time-bound) aim was set to increase UDAs and reduce intensive care unit (ICU) transfers.
Purpose of the Study:
- To evaluate the impact of a newly implemented standardized urgent direct admission (UDA) process.
- To assess changes in unanticipated ICU transfers within 12 hours of admission post-implementation.
- To measure the effect of the UDA process on overall hospital efficiency and patient safety.
Main Methods:
- A comparative analysis of unanticipated ICU transfers within 12 hours of admission before and after the UDA process implementation.
- Tracking process measures including the number of UDA orders and admissions.
- Monitoring balancing measures such as rapid response calls within 12 hours of admission.
Main Results:
- Post-implementation, 2950 UDA orders were recorded.
- The average number of UDA admissions before ICU transfer rose from 41.4 to 162.6.
- Referring clinicians reported the new process as user-friendly and superior to the prior system.
Conclusions:
- The standardized UDA process successfully enhanced patient safety and operational efficiency.
- Increased UDA utilization and a reduction in ICU transfers were key outcomes.
- Essential elements included defined clinical criteria, EHR integration with decision support, automated notifications, improved interdepartmental communication, and a quality metrics dashboard.
Background:
Direct admission can help reduce emergency department crowding, improve patient satisfaction, and decrease costs, yet there is opportunity to improve standardized processes to do so safely and efficiently. We designed and implemented a new process for urgent direct admission (UDA) at our children's hospital with the SMART (specific, measurable, achievable, relevant, time-bound) aim to increase the number of UDAs between transfer to an intensive care unit (ICU) within 12 hours from direct admission by 50% in 12 months.
Methods:
We compared unanticipated ICU transfers within 12 hours of admission (outcome) before and after implementing a standardized UDA process. Process measures included number of UDA orders and admissions; balancing measures included rapid response calls within 12 hours of admission.
Results:
A total of 2950 UDA orders were placed postimplementation. The average number of UDA admissions between ICU transfers increased from 41.4 to 162.6. Referring clinicians found the process easy to use and preferable to the previous system.
Conclusion:
Implementation of a standardized UDA process improved patient safety and efficiency by increasing UDA use and reducing ICU transfers. Key components of the process included the following: clinical criteria for UDA, an electronic health record order including clinical decision support, automatic notification to admissions management, streamlined communication across the patient placement department, the referring clinician, and the family, and a quality metrics dashboard.
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