What is important to know about your service?
The Sydney Children’s Hospitals Network includes the two tertiary paediatric hospitals: Sydney Children's Hospital, Randwick and The Children’s Hospital at Westmead. Across the Sydney Children’s Hospitals Network (SCHN) approximately 2,200 bronchiolitis patients present to our emergency departments each year. About 70% (1,545 patients) are admitted with an average length of stay of three days. Approximately 17% of patients will be transferred to the intensive care unit (ICU). Additionally, patients are transferred into our care from other hospitals who are unable to provide the level of care required. These referred patients are admitted under the care of general medicine in one of our short stay wards or are transferred directly to the ICU.
What organisational model do you use?
Dashboard tracking within the Electronic Medical Record (eMR).
What is special about the way care is delivered that is valuable for others to know?
Utilising direct access to the eMR, the SCHN built a dashboard tracking progress across a number of measures. The SCHN has the capacity to track the full bronchiolitis cohort from the past two years and compare changes over time.
The dashboard tracks patient care, providing measures such as the proportion of investigations and treatments undertaken, use and cessation of oxygen, as well as tracking factors that may impact results, such as risk factors or severity of illness.
Outcome measures, including readmission rates, are important to include so there are warnings for any changes in practice that negatively impact patient care.
The dashboard is updated daily and is accessible by emergency and general medicine departments. It is discussed at each monthly steering committee meeting and is reported to the executive.
A companion document describes options for organisational models in bronchiolitis. One option is dashboard tracking – this vignette describes the model from a local perspective.
How does it make a difference?
In the initial year, we focused on reducing time to discharge from oxygen cessation and nasopharyngeal aspiration (NPA) testing. Through quality improvement methodology we analysed an extensive data set, monitored progress through a dashboard and monthly meetings, discussed methods to improve, and educated staff to embed these changes. We have seen marked reduction in both areas, reducing time to discharge by four hours and reducing NPA testing by 32%.
What tips do you have for others?
- Engage data analytics and eMR teams early.
- Ensure executive leadership attends ward and medical meetings to show support and gain valuable feedback.
- Have sponsorship from each medical and nursing area.