Pediatric Services for a Community Hospital an Innovative Model for a Combined Emergency ‐ Inpatient Unit

Background:

Providing cost‐effective quality pediatric care is a challenge for general community hospitals. Children requiring admission need pediatric expertise and their needs can be compromised in a non‐pediatric environment. High pediatric operating costs can force community hospitals to make difficult decisions: 1.) Carrying a loss, 2.) Making less than optimal arrangements for hospital‐based pediatric care or 3.) Closing pediatric service.

Purpose:

A combined pediatric emergency‐inpatient unit may be a cost‐effective option for community hospitals to provide 24hr care in an environment sensitive to needs of children and families. It is not cost‐effective to maintain a pediatric inpatient unit with low census, short length of stay and high staff‐patient ratios. A combined emergency‐inpatient unit with improved efficiency and cost‐effectiveness is a viable choice for community hospitals to provide quality pediatric care.

Description:

The pediatric emergency‐inpatient unit combines emergency patient rooms and private inpatient rooms with a central nurse's station and integrated clinical services. Staffing is provided 24/7 by pediatric nurses, techs and Pediatric Hospitalist. Other unit considerations include: 1.) Proximity to the adult ED, and to the ambulance bay, triage area and waiting room which may be shared with the adult ED, 2.) Separation of inpatient area from ED area by design structure, 3.) Number of private ED rooms and inpatient rooms based on volumes, 4.) Cross‐trained staff care for inpatients and emergency patients, 5.) Pediatric Hospitalist with emergency care experience , 6.) Administrative model that is site specific.

Summary of Results:

Quality, patient and employee satisfaction; and cost‐effectiveness were evaluated before and/or after opening of a combined unit. Pediatric patient care and satisfaction improve when children are cared for by pediatric staff in an appropriate environment. Patient satisfaction scores increased by 10% with positive comments about the: 1.) Child‐centered environment, 2.) Family focus, 3.) Experienced staff, 4.) Seamless transition to inpatient admission, 5.) Same team caring for emergency and in‐patients. Employee satisfaction scores were high in areas of understanding job expectations, learning new skills, good work environment and work relationships. Improved patient satisfaction and quality of care result in increased patient volume. Pediatric ED volume changed from an annual decrease of 11% to an increase up to 15%. Consolidation of services improves cost effectiveness and efficiency; and operating performance improved by 14%.

A combined pediatric‐inpatient model in a community hospital is successful and a viable alternative for community hospitals to offer quality, cost‐effective pediatric services.

Author Disclosure Block:

K.R. Kingry, None.