Enhancing Clinical Efficiency by Implementing a Pediatric Care Coordinator Role

Abstract

Session D presented Thursday, September 27, 2:30-3:30 pm Purpose: ED crowding is a significant concern for hospital and nursing leadership. ED crowding threatens patient safety, increases medical errors, and prolongs length of stay. Studies have shown an association between ED crowding and throughput measures. The objective of this quality assurance project is to improve the time for door to provider for pediatric patients (aged 0-17) in a level one adult trauma, level 11 pediatric trauma center. Design: This is a staff led quality improvement project. Setting: The project setting is a Level I adult trauma, level 11 pediatric trauma center. Participants/Subjects: The pediatric dedicated nursing staff participated in this project. All pediatric patients presenting via EMS and walk-in for evaluation and treatment were included in this quality improvement project. Methods: The pediatric clinical nursing staff completed a process map of their current triage workflows and identified barriers that contributed to the delay in provider evaluation, assessment and treatment. The contributing factors included; pediatric and adult patients are triaged in same location, the same staff triage both adult and pediatrics, there is not always dedicated pediatric nurse staff assigned to work at triage, there are instances when the adult patient is made a higher priority and assigned a treatment room ahead of the pediatric patient. They completed a literature review to identify best practices to improve throughput and door to provider evaluation. Through the kaizen method, they trialed separating the adult and pediatric triage process, allocating a specific location for triaging pediatric patients located within the pediatric area, using the pediatric assessment triangle (PAT), developing and implementing a pediatric care coordinator (PCC) role, and adjusting the current nurse staffing matrix to support maintaining the PCC role. They encouraged staff feedback through daily rounds, focus group sessions, and work email. They also monitored median time to first responder to determine the impact of the change. Results/Outcomes: In 1st quarter 2016, the median time to first provider was 11 minutes. The intervention timeframe was 2nd quarter 2016. The post intervention timeframe was 3rd quarter 2016-3rd quarter 2017. During the post intervention timeframe, the EC median time to first provider was on average 6.2 minutes. This represents a 43.6% decrease in time to first provider. Staff feedback from rounds and focus groups was positive with minimal suggestions for improving the process. Implications: The results suggest implementing a PCC role, incorporating the PAT in the triage process and using a dedicated triage area for pediatric patients may improve door to provider times and may provide improvement of pediatric care in a level 11 pediatric trauma center.