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through simulated and live PDSA testing, and were as follows: patients matching specific problem natures under the Medical Priority Dispatch system; or, patients exhibiting the following symptoms: altered level of consciousness, difficulty breathing, serious hemorrhage, and/or chest pain. Improvement and sustainability were monitored using pcharts. Results Of the 5498 requests for service received from allied agencies, 77.3% (n=4252) were received from the police department and 53.0% (n=2913) were preventable. The delayed dispatch protocol was implemented with an 18.3% reduction in responses (figure 2). Conclusions The delayed dispatch protocol achieved a stable, safe reduction of responses and allowed ambulances to remain in position for life-threatening calls. Future work will further reduce immediate dispatch for eligible calls.

BACKGROUND Acute pancreatitis (AP) represents a significant disease burden in the pediatric population. The management of AP includes fluid resuscitation, pain management, and early enteral feeds. Contrary to old dogma, early enteral feeding has been shown to improve outcomes and reduce hospital length of stay (LOS), yet uptake of this approach has not been standardized. Our aim was to standardize the management of AP, increasing the percentage of patients receiving early enteral nutrition from 40% to 65% within 12 months. METHODS Between January 2013 and September 2021, we conducted a quality improvement initiative among patients hospitalized with AP. Interventions included the development of a clinical care pathway, integration of an AP order set, and physician education. Our primary outcome was the percentage of patients receiving enteral nutrition within 48 hours of admission, and our secondary outcome was hospital LOS. Balancing measures included hospital readmission rates. RESULTS A total of 652 patients were admitted for AP during the project, of which 322 (49%) were included after pathway implementation. Before pathway development, the percentage of patients receiving early enteral nutrition was 40%, which increased significantly to 84% after our interventions. This improvement remained stable. Median LOS decreased significantly from 5.5 to 4 days during this timeframe. Our balancing measure of readmission rates did not change during the project period. CONCLUSIONS Through multiple interventions, including the implementation of an AP clinical pathway, we significantly increased the proportion of patients receiving early enteral nutrition and decreased hospital LOS without increasing hospital readmission rates.

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