Children’s Minnesota takes multidisciplinary approach to improve staffing and recruitment amid RSV surge

Like other pediatric hospital systems across the country, Children’s Minnesota experienced an early respiratory syncytial virus (RSV) surge in fall 2022, resulting in longer-than-usual wait times in the emergency departments (EDs). In many cases, capacities were at their limits. This was a hardship for patient families and referring partners who sent them to Children’s Minnesota. It was also a strain on The Kid Experts™ who provide that care.

To support front-line teams, Children’s Minnesota teams joined together to implement new strategies to increase staffing and support to continue to provide the best care to patients and families.

Increased recruitment and staffing efforts

Talent acquisition worked hard to fill open positions with skilled nurses as quickly as possible. In addition, to quick scheduling and follow up with candidates, some additional tactics included: reaching out to past employees and applicants, utilizing third-party recruitment agencies, attending local career events, and posting on a variety of new and diverse job boards resulting in over 500 nurses hired. Children’s Minnesota also increased the number of agency staff in several patient-facing roles, including nurses, clinical support associates and respiratory therapists to offer support in patient care units. Additionally, Children’s Minnesota filled three cohorts for the Transition to Practice program for new graduates and those with less than 6 months experience. Given the program’s success, there are five cohorts planned for 2023.

Children’s Minnesota’s remarkable front-line staff also continued to pick up additional hours to support staffing and they were rewarded with various bonus opportunities.

Patient care support

To help support patients and their families, clinical and non-clinical helpers were deployed to emergency departments and patient care units. Patient care leaders reached out to previously identified clinical helpers who have Department of Human Services (DHS) clearance. Clinical helpers performed duties like activities of daily living, clinical documentation, medication administration, monitoring and responding to alarms, and much more to help support nursing teams and patients.

Non-clinical helpers provided assistance with wayfinding, escorting families to fast-track areas, handing out comfort items and water, answering questions and other non-clinical support as directed by Children’s Minnesota ED staff.

Hospital volunteers normalized the hospital setting by interacting with patients at the bedside or in playrooms on inpatient units. They participated in developmentally appropriate activities and helped relieve the stress of families by offering breaks or lending a listening ear. They also assisted the child life team and nursing staff with special projects or errands such as deliveries.

Focused performance improvement efforts to enhance patient flow

In late October, a 21-day rapid improvement event was launched to address capacity issues surrounding the RSV surge in anticipation of an even greater surge as the flu season began. During this time, Children’s Minnesota leaders leveraged and built improvement systems using a go-and-see method, listening to the front-line teams about what barriers they faced and collecting improvement ideas. The primary goals were to reduce the left-without-being-seen rate, decrease deferrals and increase bed capacity on each unit.

The following solutions were most successful:

• Ready Care hours were extended on evenings and weekends to provide alternate care options for low acuity patients whose option was primarily the emergency departments. Families appreciated these added options and it helped relieve ED volumes.
• Following a review of evidence and current practices, a multidisciplinary team identified the opportunity to potentially shorten the length-of-stay for patients admitted with bronchiolitis and asthma by adjusting current oxygen weaning protocols to align with evidence from national pediatric practice leaders.
• Multidisciplinary discharge readiness rounds were conducted on the 6th Floor Minneapolis and 6th Floor St. Paul.
• The admissions manager physician helped triage referrals and support referring providers with other options when Children’s Minnesota was unable to admit patients due to bed capacity.
• Fast tracks were opened in St. Paul Garden View and Minneapolis perioperative services.
• Children’s Minnesota collaborated with other hospitals in the metro to support surge tactics and coordinate placement of sick children needing hospitalization.

As a result of these efforts, Children’s Minnesota was able to provide care to the significantly increased volume of patients seen in 2022. These learnings also provided resources should volumes increase again in the future.

Minnetonka Surgery and Specialty Center reopened after two-year closure

In March 2020, Children’s Minnesota Minnetonka Surgery and Specialty Center was closed as the COVID-19 pandemic escalated in Minnesota. Many elective procedures, including ear, nose and throat (ENT) conditions, eye disorders and oral surgery were cancelled due to mandates across the country. Surgeries were consolidated to the Minneapolis and St. Paul hospital campuses to cohort resources, including staffing.

As new protocols and screenings were implemented in 2021, the volume of procedures and surgical cases at the Minneapolis and St. Paul campuses began to exceed capacity and scheduling became more challenging. Plans began to reopen the Minnetonka location for lower acuity elective cases, but because it had been closed and was no longer staffed, a dedicated team of nurses and other clinical staff was assembled to rebuild the operations; redesign the space, workflow and processes; and hire and educate new team members.

The clinical nursing spaces were set up by the new staff to optimize placement of supplies and develop processes to support patient flow from admission to discharge. The team members conducted simulations in late June 2022 to ensure everything was ready prior to opening. The final workflow redesign process was incorporated in orientation for all new team members and simulations were utilized to ensure all clinical staff understood their role and the new patient bypass process.

On July 12, 2022, the Minnetonka Surgery and Specialty Center reopened and resumed pediatric outpatient procedures for ENT conditions, eye disorders, oral surgery, dental needs, general surgery and urology. Ultrasounds, general x-rays and MRIs are also now available again at the campus’s Diagnostic Imaging Center.

Education and learnings from patients continue to be incorporated into the process flow. Staff are empowered to make decisions to create the best care experience for the patients and continue to work with their Patient Care Manager, Ashley Rue, MSN, RN, to make improvements in processes that support safe and efficient care.

Inpatient mental health unit opens at St. Paul hospital

Kids throughout the country are in an unprecedented mental health crisis that the COVID-19 pandemic exacerbated. That’s why The Kid Experts™ at Children’s Minnesota opened its first pediatric inpatient mental health unit in St. Paul and will continue to expand its mental health services.

Opening its doors on Nov. 29, 2022, the inpatient mental health unit will expand in phases, first caring for adolescent patients and once it’s fully operational, it will be the first in the east metro to serve kids as young as 6 years old. It’s also one of few inpatient units in Minnesota and the country to admit kids with more complex medical conditions and allow a parent or guardian to stay overnight with their child. More than 1,000 children and adolescents are expected to be treated at the inpatient unit annually.

The inpatient mental health unit provides a healing environment that is specifically designed for kids and youth. It includes:

• Twenty-two large private rooms that will allow a parent to stay overnight with their child.
• Design focused on natural light and calming sensory-friendly spaces.
• A multi-disciplinary care team, including psychiatrists, psychologists, licensed clinical social workers, nurses and expressive arts therapists that provide individualized treatment tailored to meet each child’s needs.