| Primary Author: | Mary Nell Suell, MD |
| Co-Principal Investigators/Collaborators: | Shelly Wilke, Kathy McCarthy, Kate Mazur, Rosalind Bryant, Heidi Russell, Marilyn J. Hockenberry |
| Organization: | Baylor College of Medicine, Section of Pediatrics |
Abstract
Background
Time-sensitive medical care is essential for pediatric patients undergoing treatment for a hematologic/oncologic condition. Such patients commonly experience acute symptoms related to routine childhood illness and/or their underlying disease or therapy. An Urgent Care Bay (UCB) staffed by a designated nurse and medical provider was established within a Cancer Center Outpatient Clinic to provide time-sensitive, same-day diagnostic and therapeutic medical care during clinic hours for our patients with acute, non-life-threatening symptoms. B A quality task force was formed to measure and report outcomes of care provided in the UCB. Our initial objective was to evaluate the type of patients referred to the UCB and to define baseline service performance.
Methods
We reviewed the number of patients seen in UCB, chief complaint, underlying diagnosis, and disposition. To establish timeliness of care, we reviewed the time of referral to the UCB provider or nurse, time of arrival to UCB, time evaluated by providers and time of initiation of treatment.
Results
Over six months, 277 children were evaluated in UCB. Patients were referred by the primary team nurse (64%), primary team MD/PNP (19%) or the on-call fellow (17%). Most frequent chief complaints upon arrival to UCB were pain (41%), fever (22%), and/or vomiting (12%). Patients seen in UCB had an underlying diagnosis of leukemia/lymphoma (132 patients; 48%), hematologic disease (98; 35%), solid tumor (34; 12%), or central nervous system tumor (13; 5%). Following assessment and treatment, 188 (68%) patients were discharged home, 73 (26%) were admitted to the inpatient unit, and 16 (6%) were transferred to the Emergency Center for a higher level of care. Patients were assessed within an average of 19 min (range 0 – 65 min) by UCB providers after arrival and treatment was initiated within 50 minutes (range 0 – 150 min) after arrival to the UCB.
Conclusion
The addition of an UCB allows for rapid assessment and initiation of treatment while avoiding unnecessary emergency room care.
© Improvement Science Research Network, 2011