Prevention Science seeks to advance the prevention research and to translate scientific advances into the promotion of healthy development for all youth. Despite tremendous progress creating a robust evidence-base and set of translational tools, elaborations and expansions for equity are required. Our collective errors of omission as prevention researchers have left prevention practitioners and policy-makers without sufficient information to identify strategies that have been demonstrated to prevent behavioral health problems in young people who identify as Black, Indigenous, or other People of Color (BIPOC). We first describe the current shortcomings of available evidence, and then we call for individual and collective action to conceptualize equity-enhancing prevention, sample more inclusively, and improve analytic approaches such that we can truly promote the healthy development of all youth.

Abstract: School climate surveys are frequently used to collect information about student experiences in school. Less is known about how educators use survey data after survey administration. This paper explores one school district’s critical use of evidence to promote equitable change. We conducted eight semi-structured interviews with district and school leaders to investigate their uses of evidence. Through our qualitative, reflexive thematic analysis, we generated six themes: (1) using evidence to provide a common language; (2) bringing attention to trends to shift staff understanding of problems, (3) making structural changes, (4) planning for professional learning, (5) following up directly with students, and (6) engaging with the community. Findings illustrate how education leaders can apply a critical lens to their generation and use of evidence. We explore how the strategic use of evidence is needed to advance the broader goal of fostering school change and improving school climate for all students.

Objective: Because admitted emergency department (ED) patients waiting for an inpatient bed contribute to dangerous ED crowding, we conducted a patient flow investigation to discover and solve outflow delays. After solution implementation, we measured whether the time admitted ED patients waited to leave the ED was reduced.

Methods: In June 2022, a team using Lean Healthcare methodologies identified flow delays and underlying barriers in a Midwest, mid-sized hospital. We calculated barriers’ magnitudes of burden by the frequency of involvement in delays. During October–December 2022, solutions targeting barriers were implemented. In October 2023, we tested whether waiting time, defined as daily median time in minutes from admission disposition to departure (ADtoD), declined by conducting independent sample, single-tailed t-test comparing pre- to post-intervention time periods, January 1–September 30, 2022 (273 days) to January 1–September 30, 2023 (273 days). Additionally, we regressed ADtoD onto pre-/post period while controlling for ED volume (total daily admissions and ED daily encounters) and hospital occupancy. A run chart analysis of monthly median ADtoD assessed improvement sustainability.

Results: Process mapping revealed that three departments (ED, environmental services [EVS], and transport services) co-produced the outflow of admitted ED patients wherein 18 delays were identified. The EVS-clinical care collaboration failures explained 61% (11/18) of delays. Technology contributed to 78% (14/18) of delays primarily because staff’s technology did not display needed information, a condition we coined “digital blindness.” Comparing pre- and post-intervention days (3,144 patients admitted pre-intervention and 3,256 patients post), the median minutes a patient waited (ADtoD) significantly decreased (96.4 to 87.1 minutes, P = 0.04), even while daily ED encounter volume significantly increased (110.7 to 117.3 encounters per day, P < 0.001). After controlling in regression for other factors associated with waiting, the intervention reduced ADtoD by 12.7 minutes per patient (standard error 5.10, P = 0.01; 95% confidence interval −22.7, −2.7). We estimate that the intervention translated to ED staff avoiding 689 hours of admitted patient boarding over nine months (ADtoD coefficient [−12.7 minutes] multiplied by post-intervention ED admissions [3,256] and divided by 60). Run chart analysis substantiated the intervention’s sustainability over nine months.

Conclusion: After systemwide patient flow investigation, solutions resolving digital blindness and environmental services-clinical care collaboration failures significantly reduced ED admitted patient boarding.