P2.O291: Interventions to Improve Hospital Flow to Decrease Boarding Time in Pediatric Emergency Department at Kings County Hospital, NY: A Quality Improvement Project

Purpose/Objectives: Admission Boarding Time (ABT) is the interval between the emergency department (ED) physician’s decision-to-admit a patient and the patient’s arrival at the inpatient unit (IPU). Longer ABTs are associated with lower quality of care, increased medical errors, prolonged hospital stays, increased ICU admissions, and increased in-hospital mortality. Our project aims to reduce the average ABT from the pediatric ED to the pediatric IPU from 165 minutes to 120 minutes at Kings County Hospital (KCH) in 6 months which amounts to a 27% reduction.

Design/Methods: Calculating Average Admission Boarding Time: We did a retrospective analysis of EPIC charts from November 2022 to October 2023. Five random dates were chosen (1, 5, 10, 15, and 20) and all admissions on these dates were checked for their ABT. We averaged the ABT of all admissions in a month to procure the monthly average ABT and all admissions in 12 months to get the annual average ABT. (Figure 1)

Needs

Assessment: We conducted a needs assessment in Dec 2023 by involving key stakeholders (Figure 2). Factors responsible for prolonged ABT or key drivers were identified as unawareness about the concept f ABT, delay in inpatient bed assignment, delay in transportation, and delays in nursing handoffs. Interventions were designed after multiple focused meetings with stakeholders (Figure 3).

Interventions: We used the Plan-Do-Study-Act (PDSA) methodology for this QI. Monthly PDSA cycles were started to address these barriers in Jan 2024. Interventions include circulating mass awareness emails, awareness sessions with pediatric and ED residents, workflow changes to ensure efficient bed assignment, partnership with the transport team, simultaneous nurses and resident signouts, and need-based assignment of IPU nurses.

Results: We are presenting the preliminary results of our QI after the first two interventions. After PDSA#1 (circulating mass awareness email) in Jan 24, no significant change was noted in ABT. After PDSA#2 (awareness sessions for pediatric and ED residents) in Feb 24, the ABT was 154 minutes (6% reduction). PDSA cycle 3 is currently ongoing which involves changing bed assignment workflow where inpatient nurses will assign beds rather than the admitting team. PDSA 4 and 5 will target transportation and nursing handoff delays, respectively.

Conclusion/Discussion: Improving awareness slightly improved ABT in our population. A multidisciplinary approach involving several key stakeholders is needed to address the issue of prolonged ABT.