Emergency Medicine: Quality Improvement
Emergency Medicine 10
Kaynan Doctor, MD, MBBS, BSc (he/him/his)
Pediatric Emergency Medicine Attending
NemoursAlfred I. duPont Hospital for Children
Wilmington, Delaware, United States
A total of 549 total dog bite laceration encounters were identified during the study period. Higher numbers of patients presented during summer months and overall volume rose by 8% over two years. Twenty percent of patients required plastic surgery consultation, and 80% of those were repaired by plastic surgery either in the PED or in the OR. The cost of patients repaired by plastic surgery in the OR was most expensive, averaging 487% compared to repair by a PED provider. Additionally, when repair was performed by plastic surgery, the length of stay increased from an average of 6 to 24 hours.
Conclusion(s): Complex dog bite laceration patients can remain stagnant in the PED or inpatient setting while awaiting definitive repair, usually under sedation and often by plastic surgery. The identification of significant cost discrepancy between the three repair processes prompted our initiative to pilot a new patient flow model supported by multiple departments. We created an option for stabilized patients to be safely discharged home or to the on-campus Ronald McDonald House with the plan to return for a time-slotted plastic surgery procedure within 12 to 24 hours. Our simulations predict a decrease in clinical care time, cost and improved patient satisfaction while maintaining the same quality of repair and ensuring improved workflow in the PED.