Children’s Hospital of Richmond at VCU Children’s Emergency Room
Richmond, Virginia
The emergency department at Children’s Hospital of Richmond at VCU uses several strategies to improve patient flow and safety and reduce the number of patients leaving without being
Children’s Hospital of Richmond at VCU Children’s Emergency Room
seen. During high-volume periods, nurses and providers care for patients in alternative treatment areas. When overflow space is open, a nurse practitioner and registered nurse can manage up to six patients to significantly reduce wait times. Patient care technicians monitor waiting room patients. Patients at risk for elopement are placed near security. Patients in police custody are direct-bedded and closely coordinated with law enforcement. Staff also partner with social work to expedite discharges when appropriate.
The pediatric emergency department also developed an evidence-based difficult intravenous access algorithm through the nurse-led practice council. The pathway guides clinicians in urgent and non-urgent situations to promote early use of ultrasound-guided IV placement and consultation with the DIVA team when appropriate. The algorithm also incorporates child life support, topical anesthetics, distraction techniques and comfort positioning to improve the patient experience. Since implementation, the 20-bed pediatric ED has seen fewer unsuccessful IV attempts, improved patient and caregiver satisfaction, enhanced safety and a more standardized approach to vascular access.