AAP outlines best practices to improve Emergency Department flow

1. The American Academy of Pediatrics (AAP) recognizes that increased utilization and decreased resources have led to emergency department (ED) overcrowding for pediatric patients, resulting in decreased quality of care and patient safety.

2. The AAP’s technical report advocates the use of evidence-based streamlining mechanisms to reduce ED crowding, such as nurse-initiated practice guidelines, flexible and predictive staffing models, and appropriate performance measures.

Rundown:  ED crowding has had a negative impact on the care that pediatric patients receive, resulting in increased wait times and length of stay in addition to decreased quality of care. Despite an increase in the rate of ED visits, the number of hospitals has decreased over time, leading to overcrowding. Other related issues include fewer resources due to an increasing patient population and lack of key subspecialists. To address these issues, evidence-based clinical pathways and guidelines have been developed to manage effective patient flow and delivery of care. The use of these guidelines, particularly in the context of ED triage, has led to improved quality of care, especially in pediatric emergencies such as bronchiolitis, asthma, croup, and appendicitis. Optimizing resources, particularly staff, is a valuable tool in the quest to improve patient outcomes in the ED. A few examples of these pathways are described below:

1. Inclusion of nurse practitioners and physician assistants to handle less complicated cases as part of the triage or treatment team has led to improvements in patient outcome. However, staffing models must allow for flexibility, as an ever-changing case milieu requires appropriate staffing adjustments.

2. Proactive planning during peak times can lead to more appropriate allocation of resources and increased efficiency. Furthermore, observation units can be utilized to relieve periods of increased volume, thereby reducing crowding and decreasing both ED length of stay and inpatient admissions.

3. The development of a hospital-wide early alert system to notify the house of decreased bed availability.

4. Early inpatient discharges must be encouraged, particularly in preparation for peak ED times, as the ED serves as the principal source of hospital admissions. Incentives to encourage early rounding and discharges should also be considered, as well as employing patient waiting rooms for those waiting for a ride home or a transfer after discharge.

5. Helpful performance measures must be developed to identify areas in need of improvement and areas of excellence within structural, process-related, and outcome categories.

Click to read the technical report, published today in Pediatrics

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