Quality And Process Improvement Initiatives Can Decrease Emergency Department Length Of Stay In Severely Injured Children
*Lori Moss, Melinda Hartenstein, *Aaron J Cunningham, *Nicholas Hamilton, Erin Burns, *Mubeen Jafri
Oregon Health & Science University, Portland, OR
Purpose: An initiative to improve transfer times from emergency department(ED) to the pediatric intensive care unit(PICU) following highest level trauma activations was conducted in a Level 1 Pediatric Trauma Center.
Relevance/Significance: Increased ED length of stay(LOS) in trauma patients is associated with segmented transitional care, prolonged hospitalization and mortality. In our system, while dedicated trauma response nurses (TRN) enable seamless transition from ED to adult intensive care units, no practitioner provides similar care for children. In order to reduce ED LOS for children, we began a process improvement initiative to address this deficiency.
Strategy and Implementation: The pediatric trauma team was surveyed. Among 60 respondents, the major hurdle to PICU admission was communication: physician-to-physician(n=34, 57%), nurse-to-nurse(n=8, 13%), or interdisciplinary nurse/physician(n=28, 47%.) The initial intervention focused on interdisciplinary communication with a standardized script. Additionally, pediatric rapid response nurses (PRRN) were identified and implemented as dedicated practitioners to respond to the highest level pediatric activations. ED LOS was measured over time.
Evaluation/Outcomes: The initiative began in February 2019. Within three months, a significant reduction in average ED LOS has been demonstrated compared with the three previous years (35 minutes versus 69 minutes, Figure 1). Interval data collection is ongoing and re-evaluation of lessons learned is planned at 6 months.
Implications for Practice: Dedicated nursing providers can allow for quicker assessment and transfer of care to the PICU in pediatric trauma.
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