How One Hospital Reduced Pediatric Emergency Transfers

At Arkansas Children’s Hospital, putting children at the center of care is always a priority. As the only hospital system in Arkansas with a patient population of solely children, the organization is uniquely positioned to improve the health of young people all over the state.

To maintain the hospital’s focus on patient safety, staff recognized there was a need to increase their speed of patient identification, as well as each patient’s potential for deterioration. By avoiding delays in recognition, they could reduce emergent transfers.

To do so, hospital staff implemented the Watcher Program to assist in proactive identification of patients who may be at high risk for deterioration based on objective and subjective criteria. The goal of the program was to reduce the rate of pediatric emergency transfers from intermediate care and medical-surgical units to the pediatric intensive care unit by 40% by the following year.

The implementation began with deploying a phased approach with pilot units, starting with the medical-surgical units, followed by intermediate care, hematology/oncology and the emergency department.

During the implementation of the program, the organization also implemented a new EHR. The Watcher Program was integrated into the EHR in the form of dashboards, header alerts and other tools that are now displayed daily during the organizational safety huddle.

Many different stakeholders from across the organization were brought together to form a multidisciplinary team, meeting regularly to discuss progress and maintain focus on continuous improvement. Additionally, the team implemented an EMR training program for staff to support the transition.

As a result, Arkansas Children’s was able to see a sustained decrease in pediatric emergency transfers by 72%. This led to a change in the staff culture, improved interdisciplinary teamwork and collaboration, and most importantly, mitigated potentially stressful and difficult situations for patients and families by maintaining focus on patient safety. The hospital also observed a 75% reduction in admissions from the Emergency Department that escalate within six hours (including non-emergent escalations) as well as a perpetually positive culture shift in the organizational risk assessment and patient safety survey.

Electronic Medical Record Adoption Model Stage 7 Validation

HIMSS is pleased to recognize Arkansas Children’s Hospitalfor their HIMSS Electronic Medical Record Adoption Model (EMRAM) Stage 7 validation.

“Arkansas Children’s has adopted a physician-led provider training program, incorporating the EMR training into the clinical curriculum for faculty, residents and fellows,” said Philip Bradley, regional director, North America, HIMSS Analytics. “The impact is improved physician satisfaction and engagement.”

“We have been able to transform the care we provide to our patients though the implementation of the Watcher Program,” said Tammy Webb, MSN, RN, NE-BC, vice president, patient care services, Arkansas Children’s Hospital. “Making tools available in the EHR has enhanced situational awareness and communication, and has resulted in improved patient outcomes. We have seen a significant and sustained decrease in emergent transfers since we started this journey in 2015. The safety of our patients is the most important measure of success, but the second most impactful measure is the interdisciplinary teamwork and collaboration we have seen across the entire organization.”

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Updated February 21, 2020