October 19, 2007

Moves cut Children’s Hospital ED wait time

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Katherine Hartmann, M.D., Ph.D.

Moves cut Children’s Hospital ED wait time

The Monroe Carell Jr. Children's Hospital at Vanderbilt recently participated in two quality improvement collaboratives organized by the Child Health Corporation of America (CHCA).

The CHCA is a national business alliance of 42 of the nation's children's hospitals that focuses on patient safety and improvement.

The two collaboratives concentrated on reducing the Pediatric Emergency Department length of stay and reducing surgical infections from ventriculoperitoneal shunts and cardiac surgical procedures.

Approximately two dozen hospitals participated in the two collaboratives. Once the results are in, the hospitals will compare findings in hopes of improving patient care.

“Quality improvement is an important aspect of what we do, and we are fortunate to have an excellent team of physicians and nurse leaders who prioritize initiatives focused on patient safety,” said Meg Rush, M.D., chief of staff at Children's Hospital.

The ED collaborative was made up of 23 children's hospitals, including Vanderbilt, and data was tracked from September 2006 to July 2007.

At Children's Hospital, the ED focused on three areas of improvement: reducing the time between patients arriving at the ED to when they are seen by a physician; reducing the time from patients being seen by a physician to a decision being made on treatment; and reducing the time from the decision being made to patients being discharged either to their home or being admitted to the hospital as an inpatient.

Gains were made in all areas, as the ED received the highest score that can be received by the CHCA, a 5.0 ranking. Children’s Hospital is the only hospital that has scored that high.

“We are so proud of our staff, the physicians and the ancillary services that we work with,” said Barb Shultz, R.N., manager of the Pediatric Emergency Department. “Each member of the team played an integral part in making positive changes for the children and the families that we serve.”

Children's Hospital was among 25 hospitals that collaborated on reducing infection rates in cardiac surgical procedures and the implantation of a ventriculoperitoneal (VP) shunt.

At Vanderbilt, several changes were made. Previously, when a VP shunt was placed in the scalp, a razor was used to remove hair at the site. The collaborative called for clippers to be used instead.

Additionally, the hospital focused on the timely administration of prophylactic antibiotics, with the goal of administering the dose zero to 60 minutes prior to the incision.

The overall interventions resulted in more than a 26 percent reduction of infection rates from before the collaborative, and led to Vanderbilt receiving a 4.5 ranking from the CHCA for sustainable improvement.

“Even though our surgical site infection rate was already low, I was very pleased that we were able to lower that rate further,” said Carolyn Maness, operating room manager at Children's Hospital. “Without the support of the entire surgical team including the surgeons, anesthesia providers and OR staff, we would not have achieved the success we did.”