Six Months Without a Pediatric Unit: Evaluating What Changed for Children, Families, Nurses and the Regional Children's Hospital
[Student Name]
University of Phoenix
NSG/557: Organizational Dynamics and Systems Thinking
Week 6 Assignment
[Instructor Name]
[Date]
The hospital, its data and all figures are a composite written for a model paper.
Six months ago, our community hospital closed its 14-bed pediatric inpatient unit and opened a four-bed pediatric short-stay unit beside the emergency department, a partnership with the regional children's hospital and pediatric readiness nurse roles. Earlier weeks of this course predicted, from a systems view, that the change could relieve one problem while creating others. This paper evaluates what happened.
The Evaluation Plan
Measures were set before the change, organized by the parts of the system mapped in Week 1: children's care, emergency department flow, families, nurses, the hospital's finances and the children's hospital. Baselines come from the twelve months before closure. Plsek and Greenhalgh (2001) note that complex systems produce effects that are hard to predict, which argues for measuring broadly rather than only where effects are expected.
Children's Care
The short-stay unit cared for 212 children in six months, most with asthma, dehydration, bronchiolitis or observation after minor injuries; the median stay was 17 hours. Twenty-one children, 9.9%, needed transfer from the short-stay unit when they did not improve, all within the criteria agreed with the children's hospital. There were no unplanned intensive care transfers within 24 hours of short-stay discharge and no deaths. Emergency department returns within 72 hours after short-stay discharge were 4.2%, similar to the former inpatient unit's rate.
Emergency Department Flow
Week 3 predicted that closure would increase pediatric boarding in the emergency department. It did. Median time from the decision to transfer to departure for children needing inpatient care elsewhere was 3 hours 50 minutes, compared with 1 hour 40 minutes for admission to the former unit. During the winter respiratory season, 11 children waited more than eight hours. The prediction was right, and the safeguards set in advance, readiness nurses on every shift and a transfer time target, determined whether a long wait was merely inconvenient or unsafe. No adverse events were attributed to boarding, but emergency nurses reported heavy workloads on those nights.
Families
Family surveys after short-stay discharge rated the experience highly, and families appreciated care close to home. Families of children transferred reported more difficulty: travel, missed work and lodging. The transportation and lodging assistance program, created in response to the community pediatrician's concern, helped 38 families. The community's petition group met with the hospital at three months and acknowledged the short-stay unit's value while asking for better support for transferred families.
Nurses
Of the 19 pediatric nurses, 3 resigned before closure, 8 took pediatric readiness roles, 5 moved to the short-stay unit and 3 transferred to other units. Two readiness nurses have completed rotations at the children's hospital. All emergency nurses completed pediatric competency training. A survey of emergency nurses found higher confidence in caring for children than before the change. Pediatric nursing expertise, which Week 1 identified as a resource for the whole hospital, has been preserved in new roles rather than lost.
The Children's Hospital
Transfers to the children's hospital rose from 142 in the prior six months to 216. During the winter surge, the children's hospital asked us to keep children it could not accept on six occasions; the short-stay unit kept four of them, extending stays under a shared care plan with telehealth consultation. The balancing loop identified in Week 3 was weakened, as predicted, but the partnership partly preserved it.
Finances
Direct pediatric costs fell by about $1.2 million a year after accounting for readiness roles and the short-stay unit, less than the $2.1 million the original closure proposal projected, because the plan added roles and support the proposal had not included.
Anchoring the Change
Kotter (2012) describes consolidating gains and anchoring new approaches as the final stages. Pediatric readiness competencies are now in emergency nurse orientation, short-stay criteria are hospital policy, and the partnership's quarterly review is on the calendar. The hospital also now tells a new story about pediatric care: "starting here," the vision written in Week 4.
The Transition for Staff
Bridges (2009) describes a neutral zone between an ending and a new beginning in which people feel uncertain and productivity may dip. Staff reported that the first two months after closure felt unsettled: readiness nurses were unsure of their new role, and emergency nurses were still learning the short-stay criteria. Weekly huddles, a readiness nurse coordinator and clear written role descriptions helped. By the fourth month, readiness nurses described their role as "a new kind of pediatric nursing," a sign that the new beginning had arrived.
Unexpected Effects
Two effects were not predicted. The readiness nurses began teaching pediatric skills to maternity nurses, improving care for newborns needing stabilization before transfer. And the partnership's telehealth consultations were used for children in the emergency department who were not admitted, reducing transfers of children who could go home with a plan. Measuring broadly revealed benefits as well as problems.
Limits of the Evaluation
Six months include only one respiratory season, and pediatric volumes vary from year to year. Comparisons with the year before closure cannot separate the effect of the change from other changes, such as the children's hospital's own expansion. The evaluation will continue at twelve and twenty-four months.
Voices From the Change
The evaluation included short interviews. A readiness nurse said, "I still take care of kids, and now I teach others to do it." An emergency nurse described winter surge nights as "the hardest shifts I have worked, but I never felt alone with a sick child." A parent whose son was transferred said the transportation program made the difference between staying with him and going home. These accounts show effects that numbers alone would miss.
Sharing Results
Results were shared with staff at a forum, with the system board in a written report and with the community at a public meeting, each including the boarding problem as openly as the successes, which maintained the trust built during the transition and showed staff that the hospital would report problems rather than hide them, even when the news was unwelcome.
Recommendations
Keep: the short-stay unit, readiness roles, emergency pediatric training and the partnership. Fix: pediatric boarding during surges, by negotiating a surge protocol with the children's hospital that includes earlier transfer decisions and a dedicated pediatric transport team for our region. Watch: family burden for transferred children, readiness nurse retention and whether the short-stay unit's volume supports its staffing. Report results to staff and the community again at twelve months.
Conclusion
Six months after closure, the short-stay unit cares safely for most children close to home, pediatric expertise has been preserved in new roles and costs have fallen. The systems prediction that pediatric boarding would rise came true, and safeguards set in advance kept it safe but not easy. Evaluating the change across the whole system, rather than only at the closed unit, showed both its benefits and the problem that still needs work.
References
Bridges, W. (2009). Managing transitions: Making the most of change (3rd ed.). Da Capo Press.
Kotter, J. P. (2012). Leading change. Harvard Business Review Press.
Plsek, P. E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323(7313), 625-628. https://doi.org/10.1136/bmj.323.7313.625
How this NSG 557 Week 6 example is structured
The NSG/557 description emphasizes the effect of change on health care delivery. This paper evaluates the change with measures set before it began, organized by the parts of the system mapped in Week 1, checks whether the unintended consequences predicted in Week 3 occurred and ends with decisions, completing Kotter's later stages. Students search this week as NSG 557 Week 6, NSG557 Wk 6 or NSG/557 Wk 6; all three are the same assignment.
NSG/557 Week 6 questions, answered
What does NSG/557 Week 6 usually ask for?
The course description emphasizes the effect of change on health care delivery. Many sections close by evaluating a change, or planning its evaluation, and recommending next steps.
Why evaluate a change against predictions?
Because systems thinking predicts effects in other parts of the system. Checking whether predicted consequences occurred tests the analysis and catches problems early.
What does anchoring change in the culture mean?
Making new approaches part of normal practice through policy, orientation, measures and the stories people tell, so the change does not fade when attention moves elsewhere.
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