This Spreading Best Practices article will share the methodology that one community hospital used to expand their pediatric census, enhance family and physician satisfaction and provide additional opportunities to strengthen and grow the skill of the nursing staff.  All details for Holy Name Hospital’s Pediatric Fast Track Program were provided by Sheryl Syby, RN, Clinical Coordinator of Pediatrics.  Sheryl has been with Holy Name Hospital since 1988.  She worked in the pediatric unit as a staff nurse until 2004, and was promoted to Clinical Coordinator of Pediatrics in 2005.

OVERVIEW
Located within a five mile radius of each other, four hospitals compete for business in Bergen County, New Jersey. Each hospital faces extreme pressure to identify their own niche which would afford them the advantage to attract new physician and patients.

The pediatric unit at Holy Name Hospital contains a minimal number of beds in addition to experiencing a slow decline in census over the last ten years. The reasons for the declining census is attributed to earlier discharges; new advances in vaccines stemming from the RSV vaccine to the H-Flu vaccine; and the shift of surgical procedures performed as same day procedures. The census issue, coupled with the competition of our very close neighboring hospitals, led the pediatric department to develop an innovative process that was to be named their “Pediatric Fast Track Program.”

IMPROVING BUSINESS/INCREASING ADMISSIONS
The Pediatric Fast Track Program is a multidisciplinary program developed identifying evidence-based practice guidelines that focus primarily on the needs of the pediatric population.  The program was accomplished by collaboration with the nursing staff, medical staff and house physicians of the Emergency and Pediatric Departments within the hospital, and private pediatricians. The primary objective of this new innovation was designed to facilitate the care of critically ill patients within the Emergency Room, while bypassing mildly ill pediatric patients from the hectic Emergency Room environment directly to an atmosphere in the pediatric unit that better supports a positive and calming experience for the pediatric patient and family.

The Fast Track program was designed to target two diagnoses: gastroenteritis and asthma. Both diagnoses are identified as the most common diagnosis that will bring the pediatric patient to seek treatment in and Emergency Room or to the primary caregiver’s office. 

Who is a Fast Track candidate? Patients are referred either directly from a private physician’s office, the Holy Name Hospital clinic, or via the emergency room after an evaluation has been established.  The process of fast track is initiated with the triage of pediatric patients in the Emergency Department.  The criteria for fast track admission require that the patient is stable and the anticipated care will be greater than two hours and less than twenty-four hours.  After such determination by the triage nurse and the Emergency Department physician, the child is then fast tracked and transferred to the Pediatric Unit.  Patients may also be fast tracked directly from a private pediatrician’s office. This is accomplished via a telephone call directly to the pediatric unit.

INCREASED ADMISSIONS/ INCREASE REFERRALS
The Fast Track program has been in existence for over one year with proven success. This is evident through the patient satisfaction results. A key measure of success has been an identified patient and family sense of decreased anxiety once removed from the Emergency Room environment.  The more serene and less hectic environment of the pediatric unit is without a doubt more suited to the needs of both the patient and family. The parents respond favorably to the nursing staff’s compassion and caring practice, the patient rooms are intimate, as the patients are in a bed or crib as opposed to a stretcher. The family as well is also provided with sleeping accommodations and entertainment via the internet, television or any toys the children may seek.

Physician satisfaction has also improved. The physicians are assured that their patients are receiving the timeliest care provided by the appropriately-skilled staff. This is turn has demonstrated an increase in patient census, which attributes to the nursing staff consistently growing and maintaining their required skill levels.

BRINGING IT ALL TOGETHER
The Holy Name Hospital Fast Track program has been able to provide the hospital with the much needed edge over the competition. Parents and physicians are more likely to return to Holy Name Hospital for services after such positive experiences.