A Multidisciplinary Quality Improvement Initiative to Improve Hospital Throughput in a Pediatric Tertiary Care Center

Overcrowding in the emergency department (ED) can lead to patient delays, increased medical errors, and increased left without being seen (LWBS) rates. Identifying systemic factors that hinder patient throughput can be beneficial to optimizing patient flow and thereby reducing LWBS rates. This quality improvement project aimed to improve hospital throughput in our pediatric tertiary care center through a multidisciplinary systemic approach.

This study included patients admitted from the ED to an inpatient medical-surgical unit on the pediatric hospital medicine service. This project was a multidisciplinary effort with participation from the ED, hospital medicine, operations center, hospital administration, and nursing, who met biweekly to review data, assess the impact of changes, and discuss new interventions. The project's key drivers were the duration of the admission process, a shared mental model of admission and discharge processes, and inpatient efficiency. The team conducted a total of 10 interventions during the study period.

The percentage of patients admitted within 90 minutes increased from the baseline of 18% to 42% by the end of the study period. The escalation of care and LWBS rates decreased by the end of the study.

A multidisciplinary approach to hospital throughput, incorporating initiatives from the ED and inpatient units for admission and discharge processes, along with the support from ancillary services, can significantly enhance patient flow throughout the hospital system.