No abstract

Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.

Introduction Pediatric patients with facial burns and advanced airway needs precipitate acute situations requiring multidisciplinary team member collaboration. Significant facial burns, particularly involving considerable edema or smoke inhalation, may warrant dental or circum-mandibular endotracheal tube (ETT) wiring for stabilization. Guidelines were created, trialed, and revised based on patient outcomes and clinician feedback at a pediatric verified burn center. Methods The guideline was created by the burn team in 2019. This standard work was utilized with pediatric burn cases presenting to the burn center. Guideline variances, such as prolonged time from door to ETT wiring, prompted a gap analysis need to improve the process. Through two case review sessions held in 2020, a multidisciplinary team consisting of the burn providers, emergency department providers, nursing, and respiratory therapists revealed process knowledge deficits, unclear role expectations, and supply issues. Literature was reviewed and a myAmeriburn listserv inquiry of current practice was made to seek additional guidance. Results Based on feedback from the multidisciplinary group and data gathered from the literature and collegial burn community, action plans and guideline modifications were developed in 2021. The respiratory therapy department developed education for their staff highlighting use of twill tape and taping. The use of ETT suturing was removed from the guidelines. Conclusions Multidisciplinary contribution and engagement was necessary to produce, execute, and evaluate the pediatric endotracheal tube wiring guidelines. Through dialogue, patient trial, and constructive feedback, guidelines were amended to produce a smoother team process and better patient experience. The standard work is currently being evaluated in its modified version.