1065: IMPROVING THE TIME OF PICU PATIENT TRANSFER ORDERS TO THE GENERAL WARD

Abstract

Introduction: Delays in patient transfer orders from the pediatric intensive care unit (PICU) to the general ward may cause holdups for new admissions. Thus, improving the PICU transfer flow will increase planned and unplanned admission capacity. Therefore, we aimed to increase Picu transfer orders to 50% before noon and 70% by 2 pm over six months. Methods: We used tableau software to monitor the PICU transfer orders and focused on the percentage of transfer orders before noon and 2 pm. Utilizing a PICU transfer process map, we recognized different areas for improvement. The team implemented a systematic approach for changes. The on-call PICU attending during sign-out identifies the patients ready or almost ready for transfer. The PICU Charge nurse gets the list and starts the bed request process. A list of the possible patient transfers is provided to the PICU Assistant to be sent to the Hospitalist admitting team. Multidisciplinary morning huddle changed to start earlier and limited to 15 minutes. Pre rounding and Rounding process were re-arranged to start earlier and finish sooner. From November to April, a third attending was added to the team to help decrease interruptions during the rounding time. Results: Our PICU’s baseline percentage of patient transfer orders before noon was 33.5 % and, before 2 pm, 44%. However, we observed an upper trend of transfer orders during the implemented changes. By the end of the six months, our noon transfer orders increased to 50% and 75% by 2 pm. Conclusions: Improving the patient transfer flow to Acute Care optimizes planned admissions readiness and the availability for unplanned admissions to the PICU. As a secondary benefit, the number of patients declines decreases.