Howard County General Hospital - Columbia, MD

During the past two years, Howard County General Hospital’s Pediatric Emergency Department has made tremendous strides in meeting and exceeding the surrounding community’s emergency pediatric care needs. Patient satisfaction scores have climbed from the 43rd percentile (July through December 2001) to the 97th percentile nationally (January through June 2003).

Much of the success can be attributed to an innovative pediatric unit model that integrates emergency, observation, and inpatient care at one location. Nurses are trained to work in both the pediatric emergency and pediatric inpatient sub-units. A hospitalist group provides the physician care for both areas.

This patient-centered pediatric care model provides a seamless transition for children and their parents. The doctor who examines the child in the pediatric emergency room writes the admitting orders. The nurse who builds a relationship with the family upon arrival continues the relationship during the inpatient stay.

Cross-training has resulted in a smooth transition from pediatric emergency care to pediatric inpatient care, thus creating a more reassuring and less stressful atmosphere for patients and their families.

The Pediatric Emergency Department’s design is also employee-centered. The Pediatric Unit vacancy rates underscore the staff’s satisfaction. During the past six months, the Registered Nurse vacancy rate has averaged 1.3% and the Patient Care Technician vacancy rate has remained at 0%. These high employee satisfaction results and low vacancy rates are directly attributable to the combined emergency/inpatient model of care.

This unique Pediatric Emergency Department/Pediatric Inpatient Unit model has resulted in the following financial and marketshare gains:

• Initial studies estimated the market share gain to be 5% per year. Actual market share gains are almost 30% per year.
• Initial estimates projected a break-even financial scenario within three years. By the fourth year, the net contribution margin was approximately $825,000 and has remained consistently high.

Leadership involvement has been key to the success of Howard County General’s patient and employee satisfaction improvement efforts. The facility’s leaders have worked hard to build a Pediatric Emergency unit that is fluid and able to make adjustments to better serve the patients and staff. Changes have included:

• Expanding unit and bed space to meet increasing patient volumes
• Adjusting staffing levels as patient volume levels increase
• Offering ongoing training to increase the staff level of competency and comfort with critical care skills