1057: PROCESS MAPPING POSTOPERATIVE PICU ADMISSIONS

Abstract

Introduction: The lack of a standard communication process around anticipated postoperative destination for patients leads to inefficiencies and staffing challenges in the pediatric intensive care unit (PICU). Many PICU admissions are unanticipated; however, many of the complex or prolonged surgical cases can be anticipated. We aim to identify opportunities in perioperative scheduling communications to facilitate optimization of staffing and efficiency for planned post-operative admissions to the PICU. Methods: Over 45 days, a daily REDCap survey was administered to PICU charge nurses aiming to identify new admissions from the operating room, whether they were considered planned, how the team learned about the new patient admission (overnight OR list, bed reservation email, call from perioperative team day of admission, etc.), and if the intended destination was posted on Epic. The perioperative team can use more than one way to notify the PICU team of an admission for one patient. There were 67 total OR admissions, but 17 of these survey submissions were removed because they were previously admitted to the PICU (n=11), they had an unforeseen surgical complication (n=3), or they were scheduled to go to the PICU and did not show up (n=3). 50 surveys were processed for their data. Results: Of the 50 survey submissions, 35% were considered unplanned by the PICU charge nurse. These unanticipated admissions resulted in one less nurse requested for the shift during which they were admitted. Of unplanned admissions, 11% were posted on the overnight OR list, 53% were called in by a perioperative team member the day of admission, and 29% appeared to the PICU without any type of communication to the team. 85% of planned admissions were posted to the overnight OR list. They also utilized bed reservation email (6%), surgery call the day of admission (3%) and the bed reservation book (21%). Conclusions: Unplanned admissions from the OR indicate scheduling communication gaps across surgical disciplines. This is likely due to the lack of standardization in communicating PICU admissions from the operating room. Since a majority of planned admissions utilized Epic and the overnight OR list for communication, we propose to make the postoperative destination field a required field within the posting process in the EHR.