No Place like Home: Reducing Hospital Admissions for Pediatric Oncology Patients
Previously, febrile pediatric oncology patients with central lines were direct inpatient admissions, sometimes unnecessarily. We collaborated with the emergency department to improve inpatient bed availability and minimize unnecessary hospital admissions. This was accomplished using standardized instructions and processes for the healthcare team to provide appropriate care and maintain our time to antibiotic administration of less than 60 minutes from patient arrival. Patients received a communication card to use as a trigger mechanism upon arrival. This work increased bed capacity and minimized hospital cost while managing crucial bed and staff shortages while allowing patients to be discharged home for optimal healing.
Problem: Previously, febrile pediatric oncology patients with central lines were directly admitted to our inpatient unit. To minimize unnecessary hospitalizations, we shifted patient management to the emergency department (ED), allowing discharge home for optimal healing. This process increased bed capacity and minimized hospital cost while managing crucial bed and staff shortages.
Measurement: A multidisciplinary team developed an aim statement, measures, key driver diagram, flow maps, a Pareto chart identifying reasons for misses and related targeted interventions, and a simplified Failure Mode and Effects Analysis. The team aimed to meet current guidelines with antibiotic administration within one hour of arrival.
Analysis: The team utilized the Model for Improvement including PDSA cycles, real time dashboards, pareto charts, and annotated run charts to evaluate and analyze the data. The ongoing evaluation process is completed after every patient encounter, with follow up for any feedback, and then monthly changes are made as needed.
Implementation: We implemented multilayered communication and interdisciplinary flow to expedite treatment. Training emphasized prompt evaluation, implanted port accessing, obtaining blood cultures and antibiotic administration per national benchmarks. Placing orders and preparing antibiotics prior to patient arrival were critical. An EPIC EMR transition threatened some processes; working with EPIC's team remedied this.
Results/Discussion: We've discharged 173 previously directly admitted patients, opening beds and potentially enabling families' cost savings of approximately $2,318,200. We continue to meet our average arrival-to-antibiotic goal at 42 minutes, thanks to placing patient orders and preparing antibiotics prior to patient arrival. We will continue data collection and monitoring for sustainability.
Speakers
Outcome Specialist - Atrium Health's Levine Children's
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Performance and Process Improvement
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Location Virtual
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Organizer NAHQ Next
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