P0020 - Improving the Hospital Admission Process and Streamlining Access to Resources for Residents

Program Goals: Senior residents coordinate all admissions to the resident and nurse practitioner teams, including in house and outside facility transfers. All pending admissions communicated to the resident are written on the Children’s Hospital Admit Record (CHAR). When patients arrive without the resident receiving hand-off from the admitting physician, this can lead to care delays given absence of orders or proper care team assignment. Due to this many residents frequently check the Bed Board, an EMR view showing all pending admissions. Lastly, there are many useful digital clinical resources such as resident schedule that are referenced frequently but can be time consuming to find.

A team of senior residents and Hospital Medicine attending/physician informaticist created an EMR-based Resident Dashboard and provided senior resident training. The main goals of implementing the Resident Dashboard were to decrease the duration of time needed to assign admits to resident teams by 25% and decrease the perceived difficulty to track admits to less than 10% (from 22% perceived Difficult or Very difficult) within six months.

Evaluation: Resident surveys pre- and post- Dashboard included time spent assigning patients, difficulty tracking admits, number of patients assigned a bed or arriving without residents receiving handoff, confidence the CHAR includes all admissions, and frequency recounting team numbers.

A total of 38 pre-intervention and 11 post-intervention resident surveys were completed. Fewer patients arrived without handoff (post 82% vs. pre 94%), and fewer reported this occurring with 2+ patients per shift (post 9% vs. pre 19%). Most described tracking admits as “somewhat difficult” (post 75% vs. pre 78%) but felt confident or very confident (post 75% vs. pre 48%) that the CHAR included all patients. There were fewer team total recounts (6+ times, post 20% vs. pre 28%) and resident schedule checking (6+ times, post 10% vs. pre 20%). However, time assigning patients to teams increased (30+ minutes, post 57% vs. pre 28%).

Discussion: While resident ability and confidence tracking admits improved many still felt this was “somewhat difficult”. Time spent assigning admits to teams increased which may reflect higher admit volumes and new resident capping policies implemented while obtaining post-data. A Resident Dashboard may be a useful tool to streamline team numbers, resources, and incoming admits. We plan to further improve Dashboard functionality by adding calculators reflecting available spots per team and additional training with the goal of ultimately improving resident confidence and efficiency as well as limiting delays in patient care.