Optimizing Sedation to Discharge Time for Orthopedic Patients in a Pediatric Emergency Department

Many fractures are reduced in the pediatric emergency department (PED), followed by discharge. We appreciated inefficiencies after sedation. We aimed to decrease the time from sedation end to discharge by 50%, from 240 to 120 minutes, for patients with simple, isolated fractures who undergo fracture reduction in the PED from May 2023 to May 2025.

A multidisciplinary team formed in May 2023. Interventions included the introduction of a portable radiograph order (mini C-arm), a sedation column on the track board, and a policy change to improve flow. The primary outcome was average time from sedation end to discharge. Process measures included percentage of encounters with the mini C-arm ordered and with postreduction films. Secondary outcome measures included average time from sedation end to discharge for patients with and without postreduction films. The balancing measure was the rate of return visits or operating room admissions within 24 hours. Retrospective baseline data were obtained from October 2022 through April 2023. Biweekly data were followed prospectively. Statistical process control charts were used to analyze data.

Of 558 total encounters, baseline centerline data represented 68 encounters with an average time from sedation end to discharge of 240 minutes. Interventions led to 3 centerline shifts with a final average time of 71 minutes.

This quality-improvement initiative with targeted, interdisciplinary interventions was associated with significantly reduced discharge times after sedation for pediatric fracture reductions. The most impactful was the introduction of mini C-arm imaging for real-time assessment of fracture reductions.