Feng Tianshu, Ajdari Ali, Boyle Linda Ng, Kannan Nithya, Burd Randall, Groner Jonathan I, Farneth R Austin, Vavilala Monica S
From the George Mason University, Fairfax, VA.
Harvard Medical School & Massachusetts General Hospital, Boston, MA.
Pediatr Emerg Care. 2024 Jun 1;40(6):421-425. doi: 10.1097/PEC.0000000000003088. Epub 2024 Jan 15.
Our study aimed to identify how emergency department (ED) arrival rate, process of care, and physical layout can impact ED length of stay (LOS) in pediatric traumatic brain injury care.
Process flows and value stream maps were developed for 3 level I pediatric trauma centers. Computer simulation models were also used to examine "what if" scenarios based on ED arrival rates.
Differences were observed in prearrival preparation time, ED physical layouts, and time spent on processes. Shorter prearrival preparation time, trauma bed location far from diagnostic or treatment areas, and ED arrival rates that exceed 20 patients/day prolonged ED LOS. This was particularly apparent in 1 center where computer simulation showed that relocation of trauma beds can reduce ED LOS regardless of the number of patients that arrive per day.
Exceeding certain threshold ED arrival rates of children with traumatic brain injury can substantially increase pediatric trauma center ED LOS but modifications to ED processes and bed location may mitigate this increase.
我们的研究旨在确定急诊科（ED）的到达率、护理流程和物理布局如何影响小儿创伤性脑损伤护理中的急诊科住院时间（LOS）。
为3个一级小儿创伤中心绘制了流程和价值流图。还使用计算机模拟模型来研究基于急诊科到达率的“如果……会怎样”的情景。
在到达前准备时间、急诊科物理布局和流程所花费的时间方面观察到差异。到达前准备时间较短、创伤病床位置远离诊断或治疗区域以及急诊科到达率超过每天20例患者会延长急诊科住院时间。这在1个中心尤为明显，计算机模拟显示，无论每天到达的患者数量如何，创伤病床的重新安置都可以缩短急诊科住院时间。
创伤性脑损伤患儿的急诊科到达率超过一定阈值会大幅增加小儿创伤中心的急诊科住院时间，但对急诊科流程和病床位置进行调整可能会减轻这种增加。
