Oral Papers: Women's Mental Health & Pediatrics
Patients with malnutrition are admitted to an adolescent unit for medical stabilization where an interdisciplinary team specializes in evaluation and management of eating disorders. A quality improvement (QI) project was started in January 2018 as the number of patients admitted with eating disorders was steadily increasing. The QI project was part of a larger initiative, Keeping Kids out of the Hospital (KKOOTH) umbrella initiative and was found to be an opportunity after comparing our length of stay data to those of other children’s hospitals through Pediatric Health and Information System data. The goal was to reduce our average length of stay (12.46 days) by 10% while delivering excellent care and decreasing staff “burnout”. To optimize staffing and conserve resources on our unit, we developed a protocol for group meals and programming known as MOORs (Meals out of Room).
Methods: The interdisciplinary team did a retrospective analysis of 2015-2017 patient data in regard to length of stay, readmission rates, vital signs, and anthropometrics to understand our current baseline and opportunities for improvement. All new patients admitted for malnutrition in March 2018 were selected as part of a 2 week pilot to participate in the MOORs program. Patients were selected by a multidisciplinary team consisting of Nursing, Adolescent Medicine, Psychiatry, Nutrition, Social Work, Child Life and Creative Arts Therapy.
Results: Collaborative interdisciplinary revision of admission criteria for selected patient population to prevent unnecessary admissions, implementation of weekly discharge rounds for patients admitted 10+ days, and the development of a clinical pathway for patient care during admission were a part of the original QI project. The MOORs pilot showed that there was positive parent and staff feedback for increased staff training, increased programming on the unit, and the start of a parent psychoeducation group. We were able to decrease length of stay.
Discussion: The data has shown that our length of stay has begun to trend down with no increase in readmissions. Staff and parents are reporting increased satisfaction. As of January 31, 2019 107 hospital bed days have been saved as part of the KKOOTH initiative. We anticipate that the go-live of our pathway in mid-2019 will help to increase standardization and further decrease length of stay. Decreasing staff burnout and increasing family satisfaction will continue to be examined through the implementation phase of the MOORs program.
Conclusion/Implications: Initial data supports that multidisciplinary teamwork and commitment to improving quality care has shown successful and as the work is sustained, we anticipate seeing continued improvements.
Peebles R, Lesser A, Park CC, Heckert K, Timko C.A., Lantzouni E, Liebman R, Weaver L: Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders. J Eating Disorders 2017; 5:7-21.