The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Thomas J. Cahill1,2, Kathy Dressman2, Scott Pettinichi1, Cynthia White1; 1Respiratory Care, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH; 2TRANSITIONAL CARE CENTER, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

INTRO: Cincinnati Children's Hospital Medical Center (CCHMC) is a 475 bed medical center with 12 clinical areas served by 198 Respiratory Therapists (RT). The Transitional Care Center (TCC) is a unique model that serves a population that requires special care and consideration. Most patients are trach and vent dependent and have been transitioned from the ICU to the TCC with intent to train caregivers for discharge to home. CCHMC saw 114,985 patients in the Emergency Department (ED) in 2009.. CCHMC considers patient flow to have a direct impact on patient safety, patient satisfaction, and as a contributor to staff satisfaction. To improve patient flow, better understanding of demand/capacity, better matching of resources, and better understanding of artificial variation-smoothing are needed to build a system of high reliability and enhance flow within the system. During the 1st quarter of 2010 the CCHMC Patient Center Flow Committee determined that the TCC had one of the worst ED discharge to unit admission times in the hospital. . An RT ED Consult program was developed to assist with decreasing wait time for a bed in the TCC. A data sheet recorded patient information and tracked the amount of time off the unit by the Respiratory Therapists. Our team tracked the time of TCC to ED notification, then time to consult and time of TCC admission. The goal was to provide this service without negatively impacting the care being provided to our current inpatients. Education was provided for the TCC RTs and the process was started on April 1, 2010 RESULTS: During the trial period April 2010-August 2010 we had a request for 25 consults. We were able to accommodate 22 of those requests (88%). Our results showed that the RTs performing consults took a mean of 18 minutes to complete the consult and return to the unit. Our targeted goal was under 25 minutes. This new process resulted in exceeding the hospital's goal of 40% of the admissions being less than one hour from the time of decision to admit. We did not track patient/family satisfaction but every family was informally interviewed by the TCC manager with no negative remarks/comments recorded for the process. DISCUSSION: The results of this test of change significantly impacted flow from the ED to the TCC. We look forward to expanding this program to other areas of the hospital and including a protocol for determining patient flow to the appropriate unit.
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