WIP 73 - Evaluating the Impact of a Newly Implemented Hospital Admission Tracker Tool in Streamlining Pediatric Emergency Department (PED) Throughput and Identifying Process Barriers

Publication Number: WIP 73.7453

Folami N.. Duncan, Johns Hopkins Children's Center, Baltimore, MD, United States; Zachary Zabriskie, University of Utah School of Medicine, Salt Lake City, UT, United States; Tai Kyung Hairston, Johns Hopkins Children's Center, Baltimore, MD, United States; Megan M. Tschudy, Johns Hopkins School of Medicine, Baltimore, MD, United States; Jianqiao Ma, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Ann Kane, Johns Hopkins School Of Medicine, Baltimore, MD, United States; Keith Kleinman, Johns Hopkins Children's Center, Baltimore, MD, United States

Background: Overcrowding in the Pediatric ED (PED) negatively impacts patient safety experience, and staff satisfaction. Best practices to reduce PED overcrowding include improving patient flow and streamlining hospital admission processes. In July 2023, a new workflow integrating EHR enhancements was implemented with the goal of improving efficiency and simplifying the provider handoff process for PED to hospital admissions. The new system harnessed technology to improve patient flow; integrating an EHR-based tool displaying real-time status updates and utilizing automation and push notifications to drive the admission process.

Objective: This study aims to evaluate the effects of the new workflow, by primarily measuring PED boarding time pre- and post-implementation, and secondarily examines associations between boarding time and various patient, hospital and temporal factors.

Design/Methods: Methods
From July 2021 through July 2024, a pre-post observational analysis of patient throughput at an urban quaternary-care hospital was performed. All pediatric patients admitted to pediatric medical teams were included. Due to differing workflows, patients admitted to the operating room, intensive care units, surgical, adult, or psychiatry services were excluded. The primary outcome was comparison of boarding time, before and after implementation. Secondarily, we explored associations between boarding time and patient level, hospital level and temporal factors.
Results
In total, 7,980 admissions were analyzed: 4,692 in the control group (July 2021–July 2, 2023) and 3,288 in the intervention group (July 3, 2023–July 2024). Preliminary results demonstrate a significant decrease in boarding times post-implementation of the new workflow, including variation based on ESI triage level, inpatient specialty and admitting unit. Further sub-analyses to control for confounding factors and explore boarding time associations are in progress. These findings may offer a model for improved efficiency and support quality improvement efforts to reduce PED boarding times by addressing system inefficiencies.