406 - A case study of how alleviating “pebbles in the shoe” can improve workflow operations in the pediatric emergency department.
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 406.3985
Diana Savitzky, NYU Grossman Long Island School of Medicine, Port Washington, NY, United States; Katrina Hernandez, New York University Long Island School of Medicine, Port Washington, NY, United States; Alexandra Reens, NYU Grossman Long Island School of Medicine, Mineola, NY, United States; Sujata Gupta, The Children’s Medical Center at NYU Winthrop Hospitan, Manhasset, NY, United States; Suchismita Datta, NYU Langone Long Island Department of Emergency Medicine, Mineola, NY, United States; Elizabeth Conklin, NYU Langone- Long Island, Merrick, NY, United States
Assistant Clinical Professor of Emergency Medicine NYU Grossman Long Island School of Medicine Port Washington, New York, United States
Background: A “pebble in the shoe” is defined as an easily fixable, small, yet frustrating issue in the workflow. Fixing “pebbles in the shoe” has been described by the American Medical Association as a way to make a positive impact on the workday and reduce physician burnout,. Our group conducted a project of identifying and fixing such “pebbles” within our entire department. In this particular study, we aim to look at the data representing pediatric emergency medicine department specifically. Objective: To improve pediatric emergency medicine (PEM) clinician well-being through a quality improvement project rooted in human-centered design, and by improving workflow operations. Outcome measures include characteristics of pebbles submitted (rate, feasibility, category of issue), number of pebbles fixed, clinician’s self-reported impact in personal well-being and workflow after participating in the project. Design/Methods: A “pebbles task force team” consisting of three emergency physicians, four pediatric emergency physicians and ED leadership (department chair, department administrator, nursing administrator, director of pediatric ED, director of supply) was established which subsequently met bi-monthly to addresses provider generated pebbles. Education was provided to all providers. A QR code was created to collect real-time pebbles. Progress on the project was provided to staff by a monthly “stop light” report. An anonymous survey was sent to 68 ED providers re: impact on self-reported well-being, and to 14 PEM providers re: impact on workflow in the department. Results: 118 pebbles were submitted over a seven month period (~17 pebbles/month). The characteristics of PEM pebbles submitted are shown in Table Tables 1 & 2. The impact on personal well-being and self-perceived impact on workflow is shown in Tables 3 & 4. An example of a traffic stoplight report is shown in Figure 1.
Conclusion(s): This project demonstrates how a team of motivated physicians and leaders can incorporate the clinician’s voice to create a better clinical work environment and improved sense of well-being with minimal cost. The pebbles project has given us a modality to raise awareness of the different needs of our patient population and streamline quality improvement processes while improving physician well-being.
