P4.010: Novel Use of a Multispecialty Group of Hospital Command Center Physicians to Centralize Pediatric Referrals and Admissions

Purpose/Objectives: Referral and admission calls are time-consuming for bedside physicians at academic hospitals. Command Centers help centralize admissions, improve bedspace utilization, and manage capacity. We built a hospital command center with a multispecialty staffing model that includes Pediatric Emergency Medicine (PEM), Pediatric Hospital Medicine (PHM), and Pediatric Intensive Care Unit (PICU) physicians. Through partnerships with the Emergency Department (ED), PHM, and PICU, we centralized ED referrals and PHM admission requests with the aim to transition referral communication tasks away from bedside physicians without compromising or varying patient placement decisions.

Design/Methods: We developed a 24/7 pediatric hospital command center that consists of a Referral Communications Center, Nurse Bed Manager, and a Command Center Physician. The Command Center Physician may be a PEM, PHM, or PICU physician who is free from all clinical duties during their command center shift. The Command Center Physician receives transfer requests and determines appropriate patient placement (i.e., acute care, ICU, ED, or discharge from referring site) for ED referral and PHM admission calls. The Command Center Physician can independently provide ED recommendations and accept transfers and admissions on behalf of ED and PHM physicians. We centralized ED referral calls and PHM admission requests on 10/14/2024 and 01/14/2025, respectively. We compared Command Center Physician patient placement decisions to both ED physician decisions made between 10/14/2024-02/25/2025 and to PHM physician decisions made between 10/21/2024-1/13/2025. We used Chi-square testing to compare patient placement decisions by group. We also calculated estimated time this transition of work saved the bedside clinician.

Results: Between 10/14/2024-02/25/2025, the Command Center Physician received 2,402 ED referral calls. The Command Center Physicians accepted patients in transfer to the ED at the same rate as PEM physicians (93% vs 93%, 0.9507) (Table 1). Given an average of 5 minutes per ED referral call, transition of this work to the Command Center Physician allows for 30 hours/month to be transitioned back to direct clinical care provided by bedside ED providers.

Between 01/14/2025-02/25/2025, the Command Center Physician received 1,166 PHM admission requests. Command Center Physicians placed patients on the acute care floor or observation unit at a similar rate compared to PHM physicians (86% vs 88%, p=0.9622) (Table 2). Given an average of 10 minutes per PHM admission request call, transition of this work to the Command Center Physician allows for 160 hours/month to be transitioned back to clinical care provided by bedside PHM providers.

Conclusion/Discussion: We demonstrate patient placement decisions by a multispecialty group of Command Center Physicians are comparable to those made by PEM and PHM physicians. This indicates that command center physicians with primary training in other pediatric subspecialties can function well in managing patient placement. This unique staffing approach can help transition non-direct clinical tasks away from bedside physicians.