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Improving Access to Short-Term Hospital Care for Pediatric Patients and their Families

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This was presented in session F3 at the Quality Forum 2014 by:

Janet Murphy
Project Manager, Clinical Planning and Quality Outcomes, Maternal Infant Child Youth Program
Fraser Health

Cassi Gray
Manager, Emergency Program, Ridge Meadows Hospital
Fraser Health

Deb Mcghie
Pediatric Emergency/Observation Unit Clinician, Ridge Meadows Hospital
Fraser Health

Murthy Korada
Pediatrician, Ridge Meadows Hospital
Fraser Health

Published in: Health & Medicine
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Improving Access to Short-Term Hospital Care for Pediatric Patients and their Families

  1. 1. Little People, Big Solutions I m proving access to short term hospital care for P aediatric P atients and their Fam ilies Deb Mcghie Janet Murphy Dr Murthy Korada Cassi Gray 1
  2. 2. Overview       Background Issue/Problem Intervention Measurement Lessons Learned Questions?? 2
  3. 3. Speaker Disclosure Statement Presenters do not have any affiliations (financial or other) to any commercial organizations 3
  4. 4. Population of Child/Youth 0-17 years in BC (2012) Total FHA: 407,038 (42%) Maple Ridge : 20,417 Catchment areas: 54,752 4
  5. 5. FHA Paediatric ED/Ambulatory Profile 2011/12 Paediatric Ambulatory/ED Visits 100,000 90,000 80,000 70,000 60,000 Ambulatory 50,000 Emergency Department 40,000 Total Visits 30,000 20,000 10,000 0 Abbotsford Regional Hospital Langley Memorial Hospital Royal Columbian Hospital Ridge Meadows Hospital Surrey Memorial Hospital Fraser Health Total 5
  6. 6. Ridge Meadows Hospital – Context  212 bed Acute care hospital  4 inpatient Paediatric beds on 10 bed Maternity unit  4 year Retroactive Data Analysis  Average of 254 Admissions/year  Average Unit Occupancy - < 29%  Average Length of Stay – 48 hours 6
  7. 7. Problem/Issue… HIGH COST QUALITY ISSUES LOW OCCUPANCY TRADITIONAL SERVICE MODEL 7
  8. 8. …or is it an opportunity…? EXISTING RESOURCES PAEDIATRIC SERVICE REVIEW SITE ENGAGEMENT HIGH GROWING POPULATION 8
  9. 9. Tristan’s story…pause for DVD clip 9
  10. 10. Intervention  Shift from in-patient model to “hybrid” 24 hour short stay assessment unit  New Paediatrician referral service  Change in Paediatrician service model  Specialized Nursing team – updated education  Active “pull” of appropriate patients from ER  patient flow algorithms  Cost neutral mandate…but investments required 10
  11. 11. Intervention – Team engagement  8 months of planning  Paediatricians, nurses, educators at RMH  Support of FHA Leadership  (site/program level)  Emergency Room Physicians/Staff  Family practices and walk-in clinics in Maple Ridge and surrounding areas  Laboratory, Radiology, Pharmacy and Registration teams 11
  12. 12. Measurement – Data Analysis num bers total 2000 1800 1600 6 w eek total 8 w eek tot 1400 1200 1000 13 w eek total 800 600 20 w eek total 52 w eek total 400 200 0 Total ER referrals GP/Clinic urgent office consult follow -ups BCCH referrals IV therapy 12
  13. 13. Measurement – Referral Criteria Patient Diagnosis Respiratory GI-gastro,constipation,etc GU-UTI Neuroseizure,concussion,febrile seizure,etc integumentary-rash,etc cardiac 13
  14. 14. Measurement – Length of Stay LOS total 900 800 700 600 500 400 300 200 100 0 up to 1 hour 1-4hours 4-12 hours 12-24 hours 24-36 hours >36 hours #transferred 14
  15. 15. Measurement – what our families told us… “We were told in advance what would be done; seen quickly. We will come back!” “Timely, informative staff; child friendly and attentive “Excellent support in ER and in follow up on Paediatrics next day…” 15
  16. 16. Outcomes  Permanent service July 2013  Exceeded Occupancy targets  4 beds - 125%; 6 beds - 84%  Time patients spent in ED decreased 11% (up to 15% for patients presenting with Fever; Moderate Shortness of Breath)  Patient/family Satisfaction rating – 4.7/5  Improved employee morale  Post Secondary Clinical Training 16
  17. 17. Tips for building a Successful Paediatric Observation Service  Early engagement of Emergency team  Addition of Paediatric Emergency Clinician Role  Targeted Education planning  Up to date Equipment inventory  Risk Mitigation planning - structures  Impact analysis - Registration, Housekeeping  Broad Communication/Dissemination Strategy 17
  18. 18. Challenges…there were a few…  Pt w LOS >24 hrs – Access to FHA Regional Paediatric Centre  Partner engagement  Unit autonomy within partnership framework  Physician Model of Care  Change in hours = some office waits  Addition of 4th Paediatrician August 2014  Success…now what?? 18
  19. 19. THANK YOU!!!! 19
  20. 20. Questions??? 20

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