142 - Multidisciplinary Approach to Improving Patient Throughput

Poster Number: 142
Publication Number: 142.1381

Background: Patient throughput in a large free-standing children’s hospital was delayed with high left-without-being-seen (LWBS) rates and prolonged lengths of stay (LOS) in the emergency department (ED). Systemic contributing factors impacted patient, team, and room readiness. To decrease the time from bed request order to patient arrival in the inpatient unit, a 90-minute bed-request-to-admission metric was implemented.

Objective: To increase the percentage of admissions within 90 minutes of bed request from a baseline of 15% in 2022 to 30% by September 2023.

Design/Methods: Patients were included if admitted from the ED to a medical-surgical unit on an inpatient general pediatric team. They were excluded if they were admitted to an intensive care unit, went directly to the operating room, or were a direct admission from an outside facility. There were no exclusions based on age or diagnoses. Multiple PDSA cycles were implemented with the outcome measure tracked on a run chart (Figure 1). The emergency medicine, hospital medicine, and nursing sections individually discussed data and interventions for their specialty and held biweekly multidisciplinary meetings to systemically review data, impact of changes, and plan new interventions. Regarding patient readiness, “Vertical ED” and “Physician-in-triage" were implemented. Interventions for room readiness included use of single-sign-on by Environmental Services to more efficiently notify staff of dirty rooms and creation of a “Flex Hospitalist” role to increase early discharge rate. Team readiness interventions included a Hospitalist entering admission orders and incorporation of a 90-minute timer on dashboards throughout the hospital. The outcome measure was percentage of admitted patients arriving from the ED to the inpatient unit within 90 minutes of bed request. Process measures included time from discharge order entry to patient leaving the hospital and time from bed request in ED to admission order placement. Balancing measures were rates of medical emergency team (MET) calls and LWBS from the ED.

Results: The percentage of patients admitted within 90 minutes increased from a baseline of 15% to 47% in September 2023. There were no increases in the balancing measures of MET calls or LWBS rates.

Conclusion(s): Addressing patient throughput utilizing multidisciplinary collaboration can improve patient flow. A limitation to this study included staff shortages.