590 - Implementing a Pediatric Care Initiation System: Effects on Throughput and Patient Experience

Publication Number: 1567.590

Lindsay H. Boles, Medical College of Wisconsin, Milwaukee, WI, United States; Sarah Thill, Medical College of Wisconsin, Milwaukee, WI, United States; Sri S. Chinta, Medical College of Wisconsin, Hartland, WI, United States; Ryan Scheper, Medical College of Wisconsin, Milwaukee, WI, United States; Kevin P. Carney, University of Colorado School of Medicine, Aurora, CO, United States; Mark Nimmer, Children's Wisconsin, Milwaukee, WI, United States; Ryan D. Conrardy, Medical College of Wisconsin, Wauwatosa, WI, United States; Danny Thomas, Medical College of Wisconsin, Brookfield, WI, United States

Background: Front-end care initiation (CI) systems are well described in adult emergency departments (EDs) and shown to improve throughput. Limited data exists on pediatric CI systems. In October 2023, our pediatric ED implemented a CI system in which patients are discharged from CI or transferred to the main ED for further evaluation. Baseline data showed shorter ED length of stay (LOS), reduced door-to-provider time, and improved experience scores for CI patients.

Objective: This study aimed to examine differences in throughput and patient experience across CI subgroups by discharge location.

Design/Methods: We conducted a matched retrospective cohort study at a single pediatric ED, including patients seen and discharged between October 2023-June 2024 who completed the NRC Health Real-Time patient experience survey. The CI cohort included patients whose care began in the CI system and was subdivided into those discharged directly from CI and those transferred to and discharged from the main ED; matched controls were selected by ED arrival date/time and Emergency Severity Index (ESI) score (1:1 for ESI 2-3, 2:1 for ESI 4-5). The primary outcome was Net Promoter Score (NPS), calculated as percentage of promoters (scores 9-10) minus percentage of detractors (scores 0-6). Secondary outcomes included LOS, pain scores, interventions, and survey responses. The Wilcoxon rank sum test compared continuous variables, and the Chi square or Fisher's exact test compared categorical variables.

Results: 366 were in the CI cohort and 585 in the matched control cohort. Among CI patients, 147 were discharged from CI and 219 from the main ED. There were small demographic differences (Table 1). Median LOS was shortest for CI discharges (93 min; IQR 63, 130) compared with ED discharges (174 min; IQR 113, 270) and controls (172 min; IQR 122, 327; p < 0.001). Maximum pain scores were lowest for CI discharges (1.76 ± 2.49; p < 0.001). CI discharges received fewer medications and diagnostic tests (p < 0.001; Table 1). ED discharges had the highest NPS (66.2; Table 2), significantly greater than controls (54.3; p = 0.034; Figure 1). CI discharges reported higher ratings for a warm and friendly environment (99%; p = 0.012; Table 2).

Conclusion(s): Patients initiated in CI and discharged from the main ED reported higher experience scores than controls despite similar throughput. Those discharged directly from CI had the shortest LOS without decreased satisfaction. Early evaluation through a pediatric CI system improves efficiency and maintains or enhances patient experience, supporting its role in optimizing pediatric ED care.

Table 1
Demographics and Outcome Measures by Discharge Location

Table 2
NRC Survey Results and Net Promoter Score (NPS) by Discharge Location

Figure 1
Pairwise Comparisons of NPS