431 - Quality Improvement Strategies for Reducing Emergency Department Discharge Length of Stay

Publication Number: 431.6517

Kelly Levasseur, Children's Hospital of Michigan, Detroit, MI, United States; Angela Hurst, Children’s Hospital of Michigan, Detroit, MI, United States

Background: Emergency departments (ED) are often overcrowded with long wait times for patients to be evaluated. In order to improve efficiency in EDs it is important to increase patient throughput and decrease overcrowding. There are many reasons for the overcrowding, one is the patient length of stay in the ED.

Objective: We planned a quality improvement initiative to decrease ED length of stay (dcLOS) including multiple “plan, do, study, act” (PDSA) events.

Design/Methods: From September 2023 to September 2024, PDSA cycles were implemented to decrease the dcLOS from an approximately 180 minutes to 125 minutes over the study time period. In September 2023 a dcLOS group was formed with leaders in the ED, including physicians and nurses. This group met monthly to discuss interventions and metrics. 5 PDSA cycles were completed including increasing triage teams, moving more nurses to the “fast track” area, implementing nurse action protocols and reporting dcLOS data to physicians at division meetings and individually.

Results: Over the study period the average dcLOS decreased from approximately 180 minutes to 125 minutes. During this period, monthly patient volumes ranged from 4,100 to 6,600, with the winter months being the busiest. Every intervention resulted in a decrease in dcLOS. The most significant change resulted from creating a discharge team, likely because they focused primarily on moving patients out of the ED at discharge. Another significant decrease in dcLOS occurred when we focused on nurse staffing in key area such as triage teams and assigning triage trained nurses to the “fast track” area. Providing individual data to physicians also resulted in some decrease in dcLOS.

Conclusion(s): This QI initiative was successful in decreasing the dcLOS. The most significant change came with the discharge team however, placing emphasis on nurse staffing in triage and “fast track” also significantly reduced the dcLOS. These interventions could also help other EDs with dcLOS. Additional time and data gathering is needed to see if these interventions result in sustained results and if dcLOS will continue to decrease at this large level 1 pediatric trauma center.

Table 1: Run Chart ED LOS
dcLOS ED QI table 1 KAL 11 4.pdfKey interventions during PDSA cycles during January 2023 to September 2024