6332 A Quality improvement project to reduce paediatric ED waiting time and length of stay at university hospital kerry from arrival to discharge (2024)

Methods Plan-Do-Study-Act (PDSA) method of QI were carried out to test if interventions resulted in an improvement. Data were collated from EHR (IPIMS) and incident report. QI tools of Process Mapping, Fishbone Diagram, Driver Diagram, Gantt chart, Stakeholder analysis, Informal Networking of Paediatric and ED staff as well as Focus Group carried out.

Queuing theory model was used to identify issues in the Emergency Department to understand the demand for care, different streams of demand, variation in times of arrival and in severity of need. Matching this with the correct supply of adequate standardized services and personnel. Secondly we Implemented MDT morning clinical handover and Evening Huddle initiatives with PDSAs 1–7 to drive and measure change.

Results The average total LOS and waiting time prior to QI project-4:60hr, post QI initiatives-3.53hr (table1). The run chart showed a shift away from the median in line with our identified gap. Trend below the median time of 4.23 from baseline (figure 1). No astronomical values. Secondly, result showed a 37% reduction in total incidents. Thirdly the Queuing theory showed average arrival per hour-1.8, arrival rate-1.5, SD-1.2. Average triage per hour-0.47, number of servers per serving rate-2.11, SD-0.3, CoV patient arrival-0.6434 and 71% utilization of triage nurse (table-1). Triage KPI in minutes, median of 28minutes, lowest of 1minute, highest of over 90minutes. The queuing theory calculations highlighted the peaks of ED attendance as generally from 13.00hour to 20.00hour. A positive unexpected benefit was the recruitment and commencement of one Paediatric ED Candidate-Advanced-Nurse-Practitioner (cANP), first of its kind to be employed in the hospital.

References

1. Al-Onazi M, et al. Reducing patient waiting time and length of stay in an acute care pediatric emergency department. BMJ Quality Improvement Reports. 2017.

2. Desmedt M and others, Clinical handover and handoff in healthcare: a systematic review of systematic reviews, International Journal for Quality-in-Health-Care 2021;33(1).

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