EMERGENCY SERVICES/CRITICAL CARE/TRAUMA/EMERGENCY PREPAREDNESS
Innovation in paediatric emergency care
improves patient experience By Denise Hudson
n innovative approach to emergency care at BC Children’s Hospital in Vancouver is reducing inpatient admissions, improving flow in the emergency department (ED) and saving health care dollars. An initiative of the Provincial Health Services Authority, the construction of the new Teck Acute Care Centre (TACC) is currently underway and scheduled for completion in late 2017. The TACC is the second phase of a three-phase BC Children’s and BC Women’s Hospital Redevelopment Project. The majority of the inpatient programs and units located in the current facilities will move into the new hospital in late 2017, including the paediatric ED. The
new hospital will mean more clinical space, 231 private, single-patient rooms, amenities for patients and families, better integrated technology and equipment and an improved healing environment. But care providers are not waiting for the TACC to open its doors to explore opportunities to enhance patient care and are initiating improvements to the delivery of healthcare now. A core team of care providers from the emergency department – including physicians, nurses and pharmacists – worked closely together to plan and test pilot a four bed clinical decision unit (CDU) within the existing ED in late 2014. A CDU is defined as a distinct area where patients from the ED are formally assigned on a short-term basis following
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INFECTION PREVENTION AND CONTROL CANADA (IPAC CANADA) HOSPITAL NEWS SEPTEMBER 2015
Emergency department staff at BC Children’s Hospital in Vancouver (from left to right): Dr. Paul Enarson, Catherine Merten, Cheryl Stevenson and Sarah Cummins. initial triage and assessment. CDUs have been designed for adult patients with success, but the concept was relatively new to paediatric emergency care. These are patients that require additional monitoring, investigation, and treatment prior to a decision to transfer to another area of the hospital or to discharge home. The benefits of a CDU include: • More efficient patient flow within the ED • Reduced inpatient admissions from ED • Reduced length of stay • Improved patient and family satisfaction • Improved clinical outcomes • Standardization of care • Effective, safe and efficient care • Reduced health care costs Established criteria for CDU patients exist for adults, but not for children and youth. Challenged with this, the dedicated team of care providers established and tested their own inclusion/exclusion criteria for transfer to the CDU. The pilot found that asthma, reactive airway disease, croup, gastroenteritis and head injuries were the top patient-visit reasons for transfer to the CDU.
A Clinical Decision Unit (CDU) is defined as a distinct area where patients from the ED are formally assigned on a short-term basis following initial triage and assessment. Initially, the CDU team faced some challenges in getting care providers to adopt the CDU concept, but continued communication, staff training and, ultimately, the data soon won them over. The CDU trial ran over a period of six months, and there were no admissions from the CDU to the paediatric intensive care unit and no adverse patient safety events were reported. The CDU diverted 157 patients who could have otherwise been admitted to an inpatient unit in the
hospital and stayed two to three times longer. In total, 947 patients were transferred to the CDU, helping to improve patient flows, freeing up clinical care spaces to assess other patients in the emergency department and contributing to overall cost avoidance. A staff survey also found that care providers felt they were better able to provide quality care overall, and those working in the inpatient units felt they had more time to focus on sicker inpatients. Patients and families reported that the CDU improved the quality of their care during their ED visit. Many of the families of patients transferred to the CDU say the quieter environment helped reduce overall stress and contributed to faster recovery or healing. They also appreciated avoiding an inpatient admission and being discharged home as soon as their child’s condition improved. “When I bring my son in for an asthma problem, we stay for long periods in the main department, sometimes up to 12 hours,” says a parent of a two-year-old patient. “During our stay this time, we were quickly transferred to the new CDU and my son actually slept, because it was a much calmer environment. We were cared for by one nurse. Everything was excellent – treatment, communication and discharge instructions from the nurse.” The ED is the busiest department at BC Children’s Hospital, seeing over 43,400 patients last year alone. When the TACC opens, a six-bed CDU will be located within the new ED, which will be three times larger than the current one. Each CDU patient room will include private bathrooms, nourishment stations and patient entertainment, all within an aesthetically pleasing, healing environment. In the meantime, while the TACC construction is underway, the proactive, innovative thinking of care providers combined with the dedication to deliver the highest possible quality of care is making a positive difference right now to patients and H families. ■ Denise Hudson is Clinical Lead, Emergency Department, BC Children’s Hospital. www.hospitalnews.com
Focus: Emergency Services, Critical Care, Emergency Preparedness and Infection Control.