title: Immediate Bedding and Patient Satisfaction in a Pediatric Emergency Department.
abstract: BACKGROUND
  Immediate bedding has been shown to increase efficiency in general emergency departments (EDs), but little has been published regarding its use in pediatric emergency medicine.
  
  
  OBJECTIVE
  Our aims were to improve door-to-provider (DTP) times and patient satisfaction and to better define the relationships between throughput times and patient satisfaction in a pediatric ED.
  
  
  METHODS
  On November 1, 2011, we changed to a new immediate bedding triage process in our academic, urban pediatric Level I trauma center. Both outcome and balancing measures were compared for the 6 months before and after this change in process. To evaluate the relationship between throughput times and patient satisfaction, we also analyzed data collected during a 32-month period.
  
  
  RESULTS
  The median DTP decreased from 44 min in the pre period to 25 min in the post period (Cohen's r value = 0.29; p < 0.001). The percent DTP < 30 min also significantly improved (pre: 31.8%, post: 58.2%, odds ratio = 2.99; 95% confidence interval 2.87-3.12; p < 0.001). For the benchmark satisfaction question of "likelihood to recommend," there was also an improvement in the mean responses (pre: 89.0, post: 92.7, Cohen's r value = 0.10; p = 0.03). There were no significant differences in the balancing measures of nurse practitioner productivity and compliance with two nurse-initiated protocols. There was a weak inverse correlation between throughput times and satisfaction scores (Spearman's rank correlation -0.18; p < 0.001).
  
  
  CONCLUSIONS
  Although immediate bedding improved the front-end efficiency in our ED, it cannot yet be considered as a "best practice" in pediatric emergency medicine.
authors.affiliation: Emergency Department, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri; Division of Emergency Medicine, Department of Pediatrics, Saint Louis University, Saint Louis, Missouri.
authors.forename: Robert
authors.initials: R
authors.lastname: Flood
authors.affiliation: Emergency Department, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri.
authors.forename: Paula
authors.initials: P
authors.lastname: Szwargulski
authors.affiliation: Emergency Department, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri; Division of Emergency Medicine, Department of Pediatrics, Saint Louis University, Saint Louis, Missouri.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Qureshi
authors.affiliation: Emergency Department, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri.
authors.forename: Mary
authors.initials: M
authors.lastname: Bixby
authors.affiliation: Emergency Department, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri; Division of Emergency Medicine, Department of Pediatrics, Saint Louis University, Saint Louis, Missouri.
authors.forename: Steven
authors.initials: S
authors.lastname: Laffey
authors.affiliation: Emergency Department, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri.
authors.forename: Ryan
authors.initials: R
authors.lastname: Pratt
authors.affiliation: Emergency Department, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri; Division of Emergency Medicine, Department of Pediatrics, Saint Louis University, Saint Louis, Missouri.
authors.forename: James
authors.initials: J
authors.lastname: Gerard
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015146:Midwestern United States; D017060:Patient Satisfaction; D010372:Pediatrics / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000379:methods; D061665:Time-to-Treatment / Q000706:statistics & numerical data
keywords: emergency medicine; immediate bedding; patient satisfaction; pediatric