Quality improvement project
In response to emergency department (ED) crowding in a public hospital I was volunteering, I worked with other health professionals to establish a Pediatric Rapid Assessment clinic (PRAC) where children would be given quick care and discharged or admitted only when necessary. The quality improvement project aimed at reducing avoidable ED admission by providing an alternative to inpatient care. As a result, ED crowding, which had for a long time affected patient safety and satisfaction in addition to prolonging length of stay, was countered. Over a span of three months, the team consisting of the chief of emergency medicine, the chief of pediatrics, physicians, nurses, quality improvement specialists, and medical students worked with the ED to help clinicians make appropriate referrals. Using the Model for Improvement developed by the Institute for Healthcare Improvement, the project’s outcome measures were geared towards reducing pediatric admission, the length of stay, and readmissions.[unique_solution] The balancing measures were time of referral, staff satisfaction, patient satisfaction, and cost-saving potential. Several improvements were made to the process intervention including: clarification of referral criteria to referring and attending physicians, transformation from manual appointment booking to electronic booking at the institution’s site, communication to referring physicians of patients who missed appointments and whether or not their referrals were appropriate. The attending physician was responsible for determining the appropriateness of referral and documented in the daily appointment register. At the end of three months, patient compliance had improved by 15% whereas the number of referring physicians had lowered by 35%. The three additions to the process map significantly improved the clinic process and brought appropriateness of referral to near 100% thereby drastically reducing avoidable pediatric admissions to the hospital. As a result, the hospital was able to improve quality of care, patient safety, and timeliness of care.