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134 - Quality improvement initiative for increasing efficiency of botulinum toxin procedures in pediatric rehabilitation clinics

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

PB

Priya D. Bolikal, MD

Associate Professor
Cincinnati Children's Hospital - University of Cincinnati COM
Cincinnati, Ohio, United States

Co-Author(s)

CC

Caitlin Chicoine, MD

Assistant Professor of Clinical Pediatrics
Caitlin Chicoine
Cincinnati, Ohio, United States
AL

Ashley Lonsbury, RN

Registered Nurse III
Cincinnati Children's Hospital Medical Center
Ludlow, Kentucky, United States
HS

Hannah K. Sullivan, MHA

Business Manager
Cincinnati Children’s Hospital Medical Center
Fort Mitchell, Kentucky, United States
BK

Brad G. Kurowski, MD, MS

Professor
University of Cincinnati and Cincinnati Childrens
Cincinnati, Ohio, United States
aG

abigail Gillman, BSN, RN II, CPN

Register Nurse
Cincinnati Children's Hospital Medical Center
Cincinnari, Ohio, United States

Objectives: For over 20 years, general pediatric rehabilitation clinics at our institution have contained a mix of new visits, follow-up visits, and botulinum toxin injection procedures. Currently, the allotted time for clinical follow-up visits and injection visits is equal. However, the active physician time needed in procedure visits is significantly less than in follow-up visits. The aim of this project was to improve efficiency of procedural visits and to right-size visit lengths to allow for improved access and improved patient and staff satisfaction while maintaining safety.

Design: We performed a quality improvement project utilizing the principles of LEAN. We created a process map and conducted time studies to better understand our current process during procedure visits. This was used to identify areas of waste, inconsistency, and burden that could be reduced. Based on the data collected, the initial intervention involved creating two separate clinic types: one for new and follow up visits, and one for neurotoxin procedures. In neurotoxin procedure clinics, we increased nursing support to facilitate medication preparation, reorganized the medication preparation room to optimize access to frequently used materials, and introduced visual aids to streamline the patient rooming process. The scheduled procedure appointment times were shortened from 30 minutes to 20 minutes to allow 50% more patients to be scheduled within the same window of time.

Results: Our initial intervention reduced the mean total visit time for neurotoxin procedures from 60 minutes to 35 minutes (42% reduction). Qualitative feedback from families, patients, physicians and nurses was positive.

Conclusions: Applying LEAN methodology to neurotoxin visits led to a 42% reduction in visit time and did not adversely affect family, patient, physician or nursing experience. For future work, we are trialing different models of clinic organization and looking at ways to further LEAN out our procedure visits.