Hasbro Children’s Hospital (HCH) is a busy pediatric hospital in Providence, Rhode Island, and a teaching hospital for the Brown University School of Medicine. Part of the Lifespan Health System, it is staffed by physicians from the University Emergency Medicine Foundation (UEMF), which is dedicated to running operationally sound and efficient emergency departments. The emergency department treats 52,000 patients a year in its 36 beds. The leadership team was looking to re-engineer patient flow and workflow to become more efficient. It had been on a journey to improve wait times and performance metrics.
In March 2014, the emergency department reported wait times to see a clinician of 72.4 minutes, something anxious parents regularly complained about. The emergency department began a number of improvement initiatives including a “pull to full” project, which traded a lengthy traditional triage process for a quick-look triage and bedside triage and registration process. The results were very promising and wait times were cut in half. However, the ED leaders—Frank Overly, MD, medical director; and Lynn Pittsinger, RN, nursing director—wanted to do more. The department was struggling to efficiently manage low acuity patients and a growing behavioral health (BH) burden. Together, the leadership formed a highly functional improvement team that included physicians—Laura Chapman, MD, Linda Brown, MD, and Elizabeth Jacobs, MD—nurses—Samantha Leary, Maureen O’Neill-Britt, Stacy Schindle—and a data analyst, Dennis Ferrante. This team developed an ambitious group of changes and prepared for implementation. The project was dubbed “Expedite to Excellence” or E2, and this appeared on posters and emails sent to staff.
A few things to note about pediatric emergency medicine patients: