Improving the Safety of Pediatric Emergency Department to Inpatient Transfers of Care

Abstract

Background: Transitions of care are a leading threat to patient safety. Vulnerabilities are intensified in emergency department (ED)-to-inpatient settings. A structure to identify and visualize high-risk patients, coupled with a process for interdisciplinary huddle prior to transport, can improve patient outcomes.

Methods: We conducted a quality improvement initiative within a tertiary-care, academic, pediatric ED. Children with respiratory disease requiring oxygen were identified to be high risk for decompensation. Digital mapping of patient data was established for clinician visibility of high-risk patients using a track-board icon in the electronic health record (EHR). We implemented interdisciplinary bedside huddles prior to ED departure. Outcome measures included escalations to advanced respiratory support (ie, noninvasive positive pressure ventilation or intubation), pediatric intensive care unit (PICU) upgrades, or rapid response systems (RRS) activations within 24 hours. Our process measure was proportion of patients with huddle completion. Our balancing measure was time from bed assignment to ED departure. Statistical process control charts were used to analyze temporal changes.

Results: Huddles were performed on 80% of high-risk respiratory patients. We observed a 53.1% reduction in advanced respiratory interventions, a 57.8% reduction in PICU upgrades, and a 59.8% reduction in RRS activations. There was no change in time from bed assignment to ED departure.

Conclusions: Through risk stratification, EHR visualizations, and interdisciplinary huddles, we achieved improved outcomes for pediatric patients. This initiative mitigates risk beyond ED care, with significant implications on hospital resources and patient safety.