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Bawazeer M, Alsowailmi B, Masud N, BenSalih A, Alfaraidi L, Said F. Immediate outcome assessment of the rapid response team of home health care services at King Abdulaziz Medical City in Riyadh. J Family Med Prim Care 2023; 12:686-693. [PMID: 37312785 PMCID: PMC10259559 DOI: 10.4103/jfmpc.jfmpc_1653_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/24/2022] [Accepted: 12/30/2022] [Indexed: 06/15/2023] Open
Abstract
Background Paediatrics rapid response team (RRT) is a newly developed service under paediatrics home health care (HHC) programme which is a standby visiting team that responds to non-critical emergency calls. The current study aimed to compare the total emergency visits and hospital admissions before and after implementation of RRT project. Method A retrospective chart review was conducted from December 2018 to December 2020. Paediatric patients registered under the home health care (HHC) programme were the target population. The admission and hospitalization rates were assessed before and after the implantation of an RRT. The variables related to patient profile were assessed to explore the association between hospitalization and admission. Result Data for 117 patients and a total of 114 calls attended under HHC covered by RRT were analysed. In the first year after the implementation of RRT, the mean number of ER visits per patient per year was reduced from 4.78 ± 6.10 to 3.93 ± 4.12 with (P value, 0.06). Also, a slight decrease in the mean number of admissions from 3.74 ± 4.43 to a mean of 3.46 ± 4.1 with (P value, 0.29). Follow-up after receiving an RRT call for an initial complaint was statistically significant in reducing both ER visits and hospital admissions within 7 days with a P value of 0.03 and 0.04, respectively. Conclusion The RRT was effective in decreasing the ER visits and hospital admissions for a very special group of patients. Additionally, the emplacement of proper triaging code at the time of attending to patients helped in reducing unnecessary ER visit and hospital admission.
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Affiliation(s)
- Manal Bawazeer
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
- Saudi Scientific Home Healthcare Society, Riyadh, Saudi Arabia
| | - Banan Alsowailmi
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
| | - Nazish Masud
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, Georgia, USA
| | - Ayah BenSalih
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
| | - Lama Alfaraidi
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
| | - Feryal Said
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
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Paydar-Darian N, Stack AM, Volpe D, Gerling MJ, Seneski A, Eisenberg MA, Hickey E, Toomey Lindsay K, Moriarty L, Hudgins JD, Falvo F, Portillo EN, Creedon JK, Perron CE. Improving Discharge Safety in a Pediatric Emergency Department. Pediatrics 2022; 150:189722. [PMID: 36222092 DOI: 10.1542/peds.2021-054307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Discharge from the emergency department (ED) involves a complex series of steps to ensure a safe transition to home and follow-up care. Preventable, discharge-related serious safety events (SSEs) in our ED highlighted local vulnerabilities. We aimed to improve ED discharge by implementing a standardized discharge process with emphasis on multidisciplinary communication and family engagement. METHODS At a tertiary children's hospital, we used the model for improvement to revise discharge care. Interventions included a new discharge checklist, a provider huddle emphasizing discharge vital signs, and a scripted discharge review of instructions with families. We used statistical process control to evaluate performance. Primary outcomes included elimination of preventable, discharge-related SSEs and Press Ganey survey results assessing caregiver information for care of child at home. A secondary outcome was number of days between preventable low-level (near-miss, no or minimal harm) events. Process measures included discharge checklist adoption and vital sign acquisition. Balancing measures were length of stay (LOS) and return rates. RESULTS Over the study period, there were no preventable SSEs and low-level event frequency improved to a peak of >150 days between events. Press Ganey responses regarding quality of discharge information did not change (62%). Checklist use was rapidly adopted, reaching 94%. Vital sign acquisition increased from 67% to 83%. There was no change in the balancing measures of median LOS or return visit rates. CONCLUSIONS The development and implementation of a standardized discharge process led to the elimination of reported discharge-related events, without increasing LOS or return visits.
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Affiliation(s)
- Niloufar Paydar-Darian
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne M Stack
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Diana Volpe
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Megan J Gerling
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Annie Seneski
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew A Eisenberg
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eileen Hickey
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katie Toomey Lindsay
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura Moriarty
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joel D Hudgins
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francine Falvo
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elyse N Portillo
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Section of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Jessica K Creedon
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Catherine E Perron
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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