(1347) SPEED to PICU: Strategic Process Enhancement in ED to PICU Admissions

Tuesday, February 25, 2025

11:15am – 12:15pm Eastern Time

Location: Connections Central - RST 13

First Author(s)

Lronid Bederman, MD

Childrens Healthcare of Atlanta
Atlanta, Georgia, USA

Co-Author(s)

OA

Omar Alibrahim, MD

PICU Medical Director; Pediatric Critical Care Medicine Fellowship Director
Duke University Medical Center, United States
SF

Stephanie Forlenza, RN

PICU Clinical Nurse
Duke University, United States
MM

Melissa McGrath, RN

PICU Clinical Nurse
Duke University, United States
AF

Anna Fritz, DNP, RN

Clinical Performance Improvement RN
Duke University, United States
Vanessa Ford, MD (she/her/hers)

Duke University Hospital
Durham, North Carolina, USA
EG

Emily Greenwald, MD

Pediatric ED Medical Director, Assistant Professor of Pediatrics
Duke University, United States
JD

Jennifer Dunnick, MD

Assistant Professor of Pediatrics
Duke University, United States

Introduction: Prolonged admission boarding time (ABT) contributes to overcrowding in emergency rooms and is associated with worse patient outcomes. Critically ill pediatric patients face unique transfer challenges, often resulting in delays and prolonged boarding. The goal of this quality improvement project is to reduce the percentage of PICU patients experiencing wait time >1 hour after inpatient bed readiness at Duke University from 25% to 10% in 12 months, with a secondary aim of reducing total ABT from a mean of 130 minutes to 90 minutes in 12 months based on internal benchmarking

Methods: A multidisciplinary team conducted a needs assessment in fall 2023 and utilized Plan-Do-Study-Act (PDSA) methodology to identify barriers to admission efficiency. Transfer-related inefficiencies, such as delays in nursing handoff/transition of care, transport team availability, and team awareness of ABT, were identified and targeted for intervention. A dashboard was created to identify and audit delays in near-real time, nursing handoff workflow was streamlined to eliminate communication waste, and new standardized transfer team assignments occurred.

Results: The percentage of patients experiencing prolonged wait after inpatient bed readiness decreased from a mean of 25% to 8.7% by the 5th monthly period. A special cause variation was seen associated with PDSA cycle #1 which focused on near-real time identification of admission delays combined with audit and feedback for staff involved in the delay. This resulted in a centerline shift from 26.5% to 14.1%, as well as centerline shift in total admission boarding time from 134 minutes to 99 minutes. There was no increase in admission-related safety events in our Safety Reporting System.

Conclusions: By involving all key stakeholders and designing institution-specific interventions, a significant reduction in the percentage of patients experiencing a prolonged wait time after bed readiness and reduced overall admission boarding time occurred. The project is on track to achieving designated improvement aims, however other unmeasured factors such as seasonal effects of hospital capacity may significantly impact results.