Presentations

Abstract

Urgent care service lines have become an important point of access to healthcare that help decrease workload on Emergency Departments. The Children's Hospital of The Kings Daughters has three urgent care centers (UCCs) in the Hampton Roads area that provide a range of services for non-emergent pediatric patients who are unable to see their PCP. CHKD UCC goals are to keep average patient length of stay (LOS) under 60 minutes, but current averages are consistently above 60 minutes. Longer LOS has been shown to correlate with lower patient satisfaction1, and has also led to increased costs due to urgent care staff staying after hours. Longer average LOS also leads to an increased workload and a lower work-life balance for staff, which has been shown to increase burnout and decrease motivation to stay in the profession2,3. To improve LOS, a large quality improvement project (QI) project is currently being developed. In order to decide where to focus QI efforts, there is a need to determine the highest time costs for the highest number of patients. A power BI dashboard was created to collect various time points from all patient visits through March, April, and May 2023. The interventions studied were strep tests, urine analyses, X-rays, splints, albuterol inhalers, and ear flushes. Strep tests, urine analyses, and X-rays had two time points: order placed to order/image collected, and then image/ sample collected to test resulted. All other interventions were measured by time ordered to order completed. A Pareto analysis of average time of intervention multiplied by the percent of patients who received that intervention was done. The Pareto analysis showed that the highest amount of time during patient stay is spent on strep test collection, followed by x-ray image collected to completed and x-ray collection. This conclusion allows a focused intervention on those specific tasks to help decrease patient LOS.

1. Walsh M, Knott JC. Satisfaction with the emergency department environment decreases with length of stay. Emergency Medicine Journal 2010;27:821-828.
2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199
3. Rotenstein, L.S., Brown, R., Sinsky, C. et al. The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19. J GEN INTERN MED (2023). https://doi.org/10.1007/s11606-023-08153-z