title: Reducing cycle times in pediatric emergency medicine.
abstract: OBJECTIVE
  Reducing cycle times in pediatric emergency medicine is an ongoing challenge to practitioners and institutions who strive to provide outstanding medical care in a caring and efficient manner amid the chaotic environment of a busy emergency department. For institutions that wish to undertake such a task, there is scant pediatric literature on these topics. The objectives of this study were to reduce emergency department cycle times and to set a benchmark in these areas for pediatric emergency medicine.
  
  
  METHODS
  After the implementation of interventions to promote efficiency, goals were chosen in 2 areas: operational and clinical cycle time reductions. The goals were set for 1 year and then followed longitudinally for an additional 4 years to evaluate sustainability of results. For the first year, the operational goal for the emergency center (EC) was to reduce the time in department (TID) from 3 hours 6 minutes to 2 hours 50 minutes, representing a 9% decrease. The corresponding goal in quick kid (QK) was to reduce the TID from 1 hour 35 minutes to 1 hour 15 minutes, representing a 21% decrease. The clinical goal for both the EC and QK was to reduce the time to initial administration of pain medications for suspected extremity fractures from 1 hour 42 minutes to 30 minutes, representing a 71% decrease.
  
  
  RESULTS
  During the initial year of the study, the mean time in the EC decreased by 9%, whereas in QK, the mean TID decreased by 16%. The time to administration of pain medications for patients with suspected fracture decreased by 58%. Longitudinal analysis revealed sustainability of in all areas studied.
  
  
  CONCLUSIONS
  At 1 year, we were able to reduce cycle times in the main EC and QK and time of pain medication administration for patients with suspected fractures. These results were sustainable over time and in the face of increasing patient volume. We anticipate this work will set benchmarks in pediatric emergency medicine for process improvement and support the development of similar programs to reduce cycle times and improve operational efficiency.
authors.affiliation: Emergency Medicine, The Children's Hospital, Denver, CO, USA. brent.alison@tchden.org
authors.forename: Alison S
authors.initials: AS
authors.lastname: Brent
authors.forename: Wassam M
authors.initials: WM
authors.lastname: Rahman
authors.forename: Lori L
authors.initials: LL
authors.lastname: Knarr
authors.forename: Julie A
authors.initials: JA
authors.lastname: Harrison
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Kearns
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lindstrom
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D019091:Critical Pathways / Q000458:organization & administration* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005431:Florida; D050723:Fractures, Bone / Q000150:complications / Q000451:nursing; D006040:Goals; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000451:nursing; D010343:Patient Admission; D010348:Patient Care Team; D013997:Time Factors
chemical_list: D000700:Analgesics