Immediate Bedding and Patient Satisfaction in a Pediatric Emergency Department

BackgroundImmediate bedding has been shown to increase efficiency in general emergency departments (EDs), but little has been published regarding its use in pediatric emergency medicine.ObjectiveOur 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.MethodsOn 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.ResultsThe 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).ConclusionsAlthough immediate bedding improved the front-end efficiency in our ED, it cannot yet be considered as a “best practice” in pediatric emergency medicine.