138 - Closer to Home: Optimizing Community Site Bed Capacity

Poster Number: 138
Publication Number: 138.416

Lisa E. Herrmann, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Brittany B. Hubbell, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Abigail Taylor, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Elena M. Duma, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Amanda Warniment, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Lauren Smith, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Karen Szczepanski, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States; Eric P. Mailloux, Cincinnati Children's Hospital Medical Center, Liberty Twp, OH, United States; Emily Schmidlin, Cincinnati Children's Hospital Medical Center, CINCINNATI, OH, United States; Michelle Mitchell, Cincinnati Children's Hospital Medical Center, Maineville, OH, United States; Brittany Gray, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Liesl Kientz, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer M. Albrecht, Cincinnati Children's, Cincinnati, OH, United States; Christine White, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Angela Statile, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Hospitalization of a child is stressful for families and may be further compounded by being away from other children, work, and home. Our community satellite (Liberty) offers comprehensive care, including emergency services, subspecialty consultation (in person and via telehealth) and surgical capabilities. Patients often present to a site of care close to where they live; yet, inpatient beds at Liberty were underutilized and unnecessary transfers to the main campus were common. We sought to increase bed capacity use at Liberty while admitting children “closer to home.”

Objective: Increase the percentage of patients admitted from the Liberty Emergency Department (ED) to the Liberty inpatient unit (LA4) from 76% to 85% by December 31, 2021. Through this process improvement, we aimed to increase the percent bed capacity use on the unit.

Design/Methods: A multidisciplinary team of nurses, ED physicians, hospitalist physicians and nurse practitioners, pediatric residents, patient flow coordinators, and family relations representatives conducted this quality improvement project. Process mapping and identification of reasons for transfer informed key drivers, which included: knowledge of available resources at Liberty, direct communication between stakeholders, inconsistencies between and within subspecialties, patient/family expectations, and perception of future need for transfer as failure. Plan-do-study-act cycles included 1) revision and dissemination of Liberty admission guidelines, 2) ED assessment bundle (multidisciplinary team bedside assessment, collaborative discussion with ED providers, documentation of decision-making), 3) targeted provider feedback, and 4) consistent messaging to patients/families. Run charts tracked the effect of interventions on median percentage of patients admitted from the Liberty ED to LA4 and percent bed capacity use. We followed established run chart rules for special cause for analysis.

Results: Median percentage of patients admitted from the Liberty ED to LA4 initially increased from 76% to 84% (Figure 1). In the setting of high census and patient transfers due to lack of beds, our measure decreased back down to 77%, though this correlated with increased bed capacity use (Figure 2).Conclusion(s): Admission of patients to sites of care close to where they live can be achieved through transparency and availability of admission guidelines, multidisciplinary communication, and collaboration regarding admission decisions. While increasing overall bed capacity use, improvements were limited by staffing shortages.
Figure 1. Percentage of Patients admitted to LA4 from the Liberty Emergency Department
Figure 2. LA4 Bed Capacity Use**This chart represents physical beds. Due to the COVID-19 pandemic resulting in staff shortages, this may not represent true number of staffed beds available for patient placement (i.e., capacity based on staffing) on any given day.