Brent Alison S, Rahman Wassam M, Knarr Lori L, Harrison Julie A, Kearns Kelly L, Lindstrom Douglas S
Emergency Medicine, The Children's Hospital, Denver, CO, USA.
Pediatr Emerg Care. 2009 May;25(5):307-11. doi: 10.1097/PEC.0b013e3181a3482b.
Reducing cycle times in pediatric emergency medicine is an ongoing challenge to practitioners and institutions who strive to provide outstanding medical care in a caring and efficient manner amid the chaotic environment of a busy emergency department. For institutions that wish to undertake such a task, there is scant pediatric literature on these topics. The objectives of this study were to reduce emergency department cycle times and to set a benchmark in these areas for pediatric emergency medicine.
After the implementation of interventions to promote efficiency, goals were chosen in 2 areas: operational and clinical cycle time reductions. The goals were set for 1 year and then followed longitudinally for an additional 4 years to evaluate sustainability of results. For the first year, the operational goal for the emergency center (EC) was to reduce the time in department (TID) from 3 hours 6 minutes to 2 hours 50 minutes, representing a 9% decrease. The corresponding goal in quick kid (QK) was to reduce the TID from 1 hour 35 minutes to 1 hour 15 minutes, representing a 21% decrease. The clinical goal for both the EC and QK was to reduce the time to initial administration of pain medications for suspected extremity fractures from 1 hour 42 minutes to 30 minutes, representing a 71% decrease.
During the initial year of the study, the mean time in the EC decreased by 9%, whereas in QK, the mean TID decreased by 16%. The time to administration of pain medications for patients with suspected fracture decreased by 58%. Longitudinal analysis revealed sustainability of in all areas studied.
At 1 year, we were able to reduce cycle times in the main EC and QK and time of pain medication administration for patients with suspected fractures. These results were sustainable over time and in the face of increasing patient volume. We anticipate this work will set benchmarks in pediatric emergency medicine for process improvement and support the development of similar programs to reduce cycle times and improve operational efficiency.
在繁忙急诊科的混乱环境中，以关怀且高效的方式提供优质医疗服务，这对儿科急诊医学从业者和机构来说，缩短诊疗周期一直是一项持续的挑战。对于希望承担此项任务的机构而言，关于这些主题的儿科文献极为匮乏。本研究的目的是缩短急诊科诊疗周期，并为儿科急诊医学在这些领域设定一个基准。
在实施提高效率的干预措施后，在两个领域设定了目标：减少运营和临床诊疗周期时间。目标设定为1年，然后纵向跟踪另外4年，以评估结果的可持续性。第一年，急诊中心（EC）的运营目标是将留观时间（TID）从3小时6分钟减至2小时50分钟，降幅为9%。快速诊疗区（QK）的相应目标是将TID从1小时35分钟减至1小时15分钟，降幅为21%。EC和QK的临床目标都是将疑似四肢骨折患者首次使用止痛药物的时间从1小时42分钟减至30分钟，降幅为71%。
在研究的第一年，EC的平均留观时间下降了9%，而在QK，平均TID下降了16%。疑似骨折患者使用止痛药物的时间下降了58%。纵向分析显示，研究的所有领域结果均具可持续性。
在1年时，我们成功缩短了主EC和QK的诊疗周期以及疑似骨折患者使用止痛药物的时间。随着时间推移且面对患者量增加，这些结果仍具可持续性。我们预计这项工作将为儿科急诊医学的流程改进设定基准，并支持开发类似项目以缩短诊疗周期并提高运营效率。
