Abstract
Introduction
Long wait times represent a common complaint of patients and their families in the pediatric emergency department (ED). Online reviews of the CHKD ED specifically indicate patients feeling “forgotten about” and waiting for multiple hours without clear reasoning. Group decision making and participation among patients, families and providers are all critical parts of care at CHKD, and negative ED experiences limit care effectiveness and patient feelings of care quality. To better understand the limitations affecting ED flow and efficiency, we performed a retrospective chart review to inform future quality improvement (QI) initiatives.
Methods
Data related to arrival and departure time, time from order to completion of x-rays, ultrasound, CT scans and lab studies, as well as demographic data such as race, insurance type, age, and gender was collected from 200 patient charts at varying timepoints between January 10, 2024, and April 10, 2026. Length of stay (LOS) was evaluated via quantile regression for different groups. Pearson correlation was used to assess the correlation between age and length of stay. All statistical tests were performed using SPSS 31.0. In addition, surveys of patient and provider feedback were collected via QR code to identify further opportunities for improvement.
Results
Among the variables collected, race, day of the week, arrival time, CT scan, ultrasound imaging and pharmacy orders did not significantly affect LOS. X-rays, room placement, lab studies, increasing age, female sex and increased acuity were all significantly associated with increased LOS. LOS varied based on admission status, with admitted patients having an average 6-hour LOS versus 3-hour average LOS for discharged patients. In surveys, both families and providers reported frustration with long wait times for radiology studies specifically, as well as a desire for more staff and improved communication about expected wait times.
Conclusion
While limited in sample size, this study allows for further targeted QI improvement projects, particularly related to significantly increased LOS for x-ray imaging and lab studies. A better understanding of patient flow, sources of delay and inefficiency within the CHKD ED will help identify opportunities to improve existing systems, enhance the patient experience, and increase provider satisfaction.