Reducing Admission Boarding Time from the Pediatric Emergency Department to the Pediatric Inpatient Unit – a Quality Improvement Project in Progress at Brookdale University Hospital Medical Center

Purpose/Objectives: Prolonged admission boarding time (ABT) has been recognized as a common phenomenon in hospitals worldwide with negative ramifications for patients, clinical staff, and health care institutions. Delayed admission boarding leads to emergency room congestion, higher rates of medical errors, low quality of care, increased cost of care, and staff frustration. Studies have shown a potential saving of $1.5- $5.0 million per year by reducing the pediatric ABT by 1 hour in a tertiary teaching hospital in a major city in the US (Boston’s Children Hospital, 2017). Reducing ABT will improve the overall quality of care and health outcomes at a relatively lower cost. The aim of this QI project is to decrease the average pediatrics ABT at Brookdale University Hospital Medical Center (BUHMC) from 163 to 120 min in 6 months, which will represent a 26 % reduction in ABT.

Design/Methods: The PDSA (Plan-Do-Study-Act) methodology was used after a needs assessment was conducted in July 2020. Significant barriers to early admission boarding were identified and a bi-weekly PDSA cycle was started in December 2020. Interventions were designed to address the lack of staff awareness on the concept of ABT, unavailability of floor nurses during admissions, delayed patient bed readiness, and delayed patient transfer from the emergency department to the pediatric floor (Fig. 1). These factors were shown to be the major cause of admission delays. Specifically, floor nurse break rules were enforced, and backup nursing staff was provided for admissions during busy floor hours. Patient bed readiness was ensured within 1 hour of patient disposition, and patient transport staff vacancies were filled with permanent staff.

Results: The mean ABT decreased from 163 min to 83 min by the 7th bi-weekly period and remained mostly under the target goal of 120 min for the next 9 consecutive bi-weekly periods (Fig. 2). A special cause variation was seen associated with PDSA cycle #4 which addressed patient transportation issues, resulting in a center-line shift from 124.7 to 91.6 minutes (Fig. 2). There was no increase in the floor to PICU transfers within 12 hours of floor admission.

Conclusion/Discussion: Involving all major key players, and implementing facility tailored interventions reduced the admission boarding time to under 120 min in 3 months. A well-planned QI project with multidisciplinary participation can improve quality-of-care indicators and possibly improve patient outcomes.