TOP 9 - Bringing Care Closer: A Quality Improvement Effort to Decrease Pediatric Hospital Medicine Length of Stay through Geographic Co-Horting

Publication Number: 3813.TOP 9

Stephanie Abuso, Boston Children's Hospital, Brookline, MA, United States; Alexandra M. Falsey, Boston Children's Hospital, Providence, RI, United States; Stephanie Hadley, Boston Children's Hospital, Boston, MA, United States; Amanda Growdon, Boston Children's Hospital, Boston, MA, United States; Julie Ferullo, Boston Children's Hospital, Boston, MA, United States; Katherine Pumphrey, Boston Children's Hospital, Boston, MA, United States

Background: Due to a variety of factors, pediatric hospital capacity has decreased nationally, leaving hospitals vulnerable to capacity constraints. At our free-standing quaternary children's hospital, capacity constraints often resulted in fragmented bed placement for children admitted to Pediatric Hospital Medicine (PHM) and the concern for disjointed care resulting in increased length of stay (LOS). Prior research in adult populations has shown that geographic co-horting improves provider satisfaction, efficiency, and interprofessional collaboration.

Objective: Our SMARTIE aim is to decrease LOS for PHM from 79 hours to 75 hours by January 2026 inclusive of race, child opportunity index, and language.

Design/Methods: An interdisciplinary quality improvement team was created, and the Model for Improvement applied. Stakeholder feedback identified the creation of fishbone diagram (Figure 1) and driver diagram with associated change ideas (Figure 2). PHM at our institution has approximately 2,500 hospital encounters annually with three resident PHM teams included in this improvement effort. Measures include LOS (primary outcome), optimal placement as per the cohorting model (process), number of hospital floors per PHM team (process), intensive care unit activations/transfers (balancing). Seven Plan-Do-Study-Act (PDSA) cycles (Table 1) have been completed since February 2024. Measures are analyzed by statistical process control (SPC) charts with improvement defined according to standard Associates in Process Improvement rules. This project does not meet the criteria for human subject research by the hospital's IRB.

Figure 1: Fishbone Diagram
The diagram illustrates the factors contributing to inefficiencies in discharge workflow and communication which informed the development of primary and secondary drivers in the subsequent key driver diagram.

Figure 2: Key Driver Diagram
The model displays the project's SMARTIE aim, primary and secondary drivers, and associated change concepts.

Table 1: Plan-Do-Study-Act (PDSA) Cycles
Seven Plan-Do-Study-Act (PDSA) Cycles were completed since February 2024. This table outlines each of the seven cycles and includes the name of the intervention, a description of the intervention, and whether the intervention was adopted, adapted, or abandoned.