A Quality Improvement Initiative to Increase the Opportunity of Play Activities and Reduce the Screen Time Among Children Admitted in Hospital Setting of a Tertiary Care Centre, North India

Objective To increase the time spent by children on play activities and reduce screen time on daily basis from baseline to 25% over the period of 10 wks in hospital setting of a tertiary care centre, North India. Methods The quality improvement design was chosen and the study was conducted in the pediatric surgery and medicine wards of a tertiary care centre in North India. The participants of the study were children admitted in the medical and surgical wards, their caregivers and health care personnel (both nurses and physicians) working in the respective wards. The study was conducted in three phases: planning, development and implementation phase. In planning phase, the baseline assessment of outcome and process measures was performed and the root cause analysis was done which revealed that there was problem with the procedure and policy. This is why day-to-day play implementation procedure protocol development and implementation was chosen as a change based on Eisenhower's matrix. In development phase, day-to-day play implementation procedure protocol was developed and was implemented in the units by using PDSA (Plan, Do, Study and Act) model. Three PDSA cycles were conducted. The outcome measures were 'the time spent by the child on play activities on daily basis' (calculated by the time spent by child in play/total time the child was awake in a day) and 'the reduction in screen time' (calculated by the average time spend by the child on android based phone in a day). The process measures were day-to-day play implementation score, time spent by child on play activities and screen time on daily basis during hospitalization. The data was collected by the team members and the investigator. Results At the end of all PDSAs, the day-to-day play implementation score and time spent on play activities increased by 50% and 20% respectively and the screen time reduced to 73%. Though the outcome measures were nearly achieved, the continuous efforts are still required to ensure sustainability and future incorporation of play in day-to-day routine of hospital care. Conclusion This QI initiative helped in increasing the play opportunities and reducing the screen time in wards. Hence, both the process and outcome measure were nearly achieved, whereas sustainability remained an issue.