Why The Wait? Reducing Length of Stay for Patients with Lacerations

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The Ohio State University

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Introduction: Patients with facial/scalp lacerations navigate several steps prior to wound repair. These steps include intake, triage, assignment to an exam room, and assessment by a provider who then orders topical anesthetic gel. This gel requires 30 minutes to reach full effect before the repair procedure can begin. The following describes an evidence-based practice project aimed at reducing overall length of stay (LOS) for patients with facial/scalp lacerations presenting to the urgent care of a large urban pediatric hospital. Methods: A literature search was conducted for articles relevant to using topical anesthetics in triage. The articles were critically appraised for strength of evidence and relevance to the project. The evidence revealed that using topical anesthetic gels in triage can decrease LOS, a key driver of patient/caregiver satisfaction. The project's intervention is the implementation of a workflow in which triage nurses ask a provider to assess the patient's laceration during triage and, if appropriate, order topical anesthetic gel to be administered immediately. LOS data were trended before and after the intervention. Results: The data showed a 48-minute decrease in average LOS. The analysis was compounded by a significant fluctuation in patient volumes due to a nationwide surge in pediatric respiratory viruses. Despite this, additional ad-hoc analysis demonstrated that the intervention had an effect in the demonstrated reduction in LOS (Cohen's d = 0.46). Discussion: These results indicate that expansion of the new workflow across the healthcare network may be beneficial in helping to decrease LOS for similar patients across other sites.



anesthetics, child, length of stay, triage