PC1239: The “barn Door” Project: Creating a Fast Track Within Pediatric Urgent Care to Improve Patient Flow and Wait Times

Purpose/Objectives: In 2020, Children’s Hospital Colorado opened a new Dual Track™ Emergency Department and Urgent Care (ED/UC) site. In 2021, this site saw over 35,000 patients. When patient volumes continued to rise in the fall of 2021, UC door-to-provider time and length of stay (LOS) increased significantly. In October through December of 2021, the UC’s median door-to-provider time was 78 min [interquartile range (IQR) 24-133] and the median LOS was 158 min [IQR 98-217]. With this Quality Improvement (QI) Project, we aim to improve patient flow with a goal to (1) decrease median UC door-to-provider time to < 30 min and (2) decrease median UC LOS to < 60 min by July 2022.

Design/Methods: A multidisciplinary QI team was formed to evaluate existing processes and design and implement interventions. Using Lean framework, the team mapped the current UC front-end process, brainstormed interventions, and created a new workflow for the front-end using existing, unused space (aka the “Barn Doors”). Key changes included 1) creating a fast track (FT) area for patients with very low acuity complaints, 2) defining chief complaints appropriate for rapid turnover in FT, and 3) creating a FT nurse/provider team to see patients in tandem.

Results: In the 3 months following implementation of the FT system on Jan 4, 2022, the median UC door-to-provider time decreased 54% to 36 min [IQR 17-54], and the median UC LOS decreased 28% to 113 min [IQR 57-170]. Additionally, our left-before-formal-evaluation (LBFE) rates for the combined ED/UC decreased from 6.8% to 1.9%, the median number of UC patients left waiting to be seen when UC closed decreased from 5.8 to 0, and there was an improvement in our ED patient LOS and door-to-provider time (balancing measures).

Conclusion/Discussion: Using QI methodology and a Lean framework, we implemented a new FT system in our UC which reduced both LOS and door-to-provider time for patients without negative impact on higher acuity ED patients. This process improvement project can serve as a framework for other urgent cares to improve throughput metrics by defining very low acuity patients for rapid evaluation and discharge from the system.