A resident-led QI initiative to improve pediatric emergency department boarding times

Theodore Kouo, Theodore Kouo, Keith Kleinman, Keith Kleinman, Hanae Fujii-Rios, Oluwakemi Badaki-Makun, Oluwakemi Badaki-Makun, Julia Kim, Julia Kim, Lucas Falco, Therese L. Canares, Therese L. Canares

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Pediatric emergency department (PED) overcrowding and prolonged boarding times (admission order to PED departure) decrease quality of care. Timely transfer of patients from the PED to inpatient units is a key driver that relieves overcrowding. In 2015, PED boarding time at our hospital was 10% longer than the national benchmark. We described a resident-led quality-improvement initiative to decrease PED mean boarding times by 10% (from 173 to 156 minutes) within 6 months among general pediatric admissions. METHODS: We applied Plan-Do-Study-Act (PDSA) methodology. PDSA 1 (October 2016) interventions were bundled to include streamlined mobile communications, biweekly educational presentations, and reminder signs. PDSA 2 (August 2017) provided alternative workflows for senior residents. Outcomes were mean PED boarding times for general pediatrics admissions. The proportion of PICU transfers within 12 hours of admission served as a balancing measure. Statistical process control charts were used to analyze boarding times and PICU transfer rates. RESULTS: Leading up to PDSA 1, monthly mean boarding times decreased from 173 to 145 minutes and were sustained throughout the study period and up to 1 year after study completion. The X-bar chart demonstrated a shift with 57 consecutive months of mean boarding times below the preintervention mean. There were no changes in PICU transfer rates within 12 hours of admission. CONCULSIONS: Resident-led quality improvement efforts, including education and streamlined workflow, significantly improved PED boarding time without causing harm to patients.

Original languageEnglish (US)
Article numbere20191477
Issue number6
StatePublished - Jun 1 2020

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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