2.50
Hdl Handle:
http://hdl.handle.net/10755/162375
Type:
Presentation
Title:
Improving Patient Access through Teamwork (IMPACT)
Abstract:
Improving Patient Access through Teamwork (IMPACT)
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:DeMarco, Frank, RN
P.I. Institution Name:Duke University Hospital Emergency Center
Title:Clinical Operations Director
Contact Address:2301 Erwin Rd, DUMC 100100, Durham, NC, 27710, USA
Contact Telephone:919-668-4904
Co-Authors:Arnie Boardwine, RN, BS, CEN; Candance Van Vleet, RN, NREMT-P
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: Improving Emergency Department (ED) throughput and patient satisfaction are long standing challenges facing healthcare organizations. Average length of stay, left without being seen, patient satisfaction are all metrics used to define the quality of performance demonstrated by an ED. Efforts to improve these metrics are often driven by hospital administrators and leadership and fail to take in to account the experience and expertise of the bedside clinician. Furthermore, strategies are often thought of in terms of nursing or physician scope and ED vs inpatient areas. This leads to lack of buy in by bedside clinicians. To achieve greater impact and support, this ED set out to create a culture of change.

Setting: An urban academic level 1 trauma and tertiary care hospital ED with an average annual census of 70,000 visits.

Methods: Multiple interprofessional teams were established, each tasked with various aspects of ED operations. The overall goal of these teams was to utilize a rapid cycle change approach, a common engineering-management strategy that has demonstrated widespread success in many industries. The Core Teams which were established include Triage, Evaluation, Disposition, Service Excellence, and Ancillary Support. Each team was led by bedside ED nurses and physicians. The teams brainstormed strategies though benchmarking, literature review, and workflow observations. Rapid cycle change initiatives were developed from these strategies and implemented on a weekly basis. Each initiative was measured for success and progress reported on weekly to leadership. The rapid cycle change initiatives designed by the staff led Core Teams included the following: EMS direct bed placement, Nurse First in the waiting room, dedicated triage physician, hourly nursing comfort rounds, bedside nursing change of shift report, 2hr reassessment of all patients waiting for treatment, a video displayed in the waiting room with repeating information about patient visit expectations and patient acuity and flow process, grease boards in each room with the patient's caregivers' names listed, nurse eats - patient eats, administrative rounding, standing orders, real time patient satisfaction surveying at the point of care that includes service recovery if needed, MD disposition within 2.5hrs of arrival, MDs discharging patients, "Dot & Plot" charge nurses tracking and reporting to staff at shift change the number of patients seen, admitted, and LWBS, charge nurse and physician rounding, and phoning treated and released patients back within 24 hours of discharge by the emergency medicine physicians.

Results/Outcomes: From 08 October through 09 December patient satisfaction scores rose by 12% (77.3 to 86.6), LWBS rate decreased by 9% (12.5 % to 3.5%), ED average length of stay decreased by 1.5 hours (6.4 to 4.9hrs). Closer analysis demonstrates an 18 % increase in ED volume from 08 July through 09 December. The most effective strategy that impacted ED throughput and patient satisfaction was the implementation of the staff led Core Teams. These teams have created an ED culture of service excellence and performance improvement. This overwhelming leadership by front line staff has motivated physicians and nurses to accept the ownership for process improvement.

Implications: To sustain a culture of performance improvement, strategies to impact ED throughput and patient satisfaction need to be led and facilitated by bedside clinicians and validated by performance data, staff and the patient.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImproving Patient Access through Teamwork (IMPACT)en_GB
dc.identifier.urihttp://hdl.handle.net/10755/162375-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Patient Access through Teamwork (IMPACT)</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">DeMarco, Frank, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Duke University Hospital Emergency Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Operations Director</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2301 Erwin Rd, DUMC 100100, Durham, NC, 27710, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">919-668-4904</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">frank.demarco@duke.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Arnie Boardwine, RN, BS, CEN; Candance Van Vleet, RN, NREMT-P</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/><br/>Purpose: Improving Emergency Department (ED) throughput and patient satisfaction are long standing challenges facing healthcare organizations. Average length of stay, left without being seen, patient satisfaction are all metrics used to define the quality of performance demonstrated by an ED. Efforts to improve these metrics are often driven by hospital administrators and leadership and fail to take in to account the experience and expertise of the bedside clinician. Furthermore, strategies are often thought of in terms of nursing or physician scope and ED vs inpatient areas. This leads to lack of buy in by bedside clinicians. To achieve greater impact and support, this ED set out to create a culture of change. <br/><br/>Setting: An urban academic level 1 trauma and tertiary care hospital ED with an average annual census of 70,000 visits. <br/><br/>Methods: Multiple interprofessional teams were established, each tasked with various aspects of ED operations. The overall goal of these teams was to utilize a rapid cycle change approach, a common engineering-management strategy that has demonstrated widespread success in many industries. The Core Teams which were established include Triage, Evaluation, Disposition, Service Excellence, and Ancillary Support. Each team was led by bedside ED nurses and physicians. The teams brainstormed strategies though benchmarking, literature review, and workflow observations. Rapid cycle change initiatives were developed from these strategies and implemented on a weekly basis. Each initiative was measured for success and progress reported on weekly to leadership. The rapid cycle change initiatives designed by the staff led Core Teams included the following: EMS direct bed placement, Nurse First in the waiting room, dedicated triage physician, hourly nursing comfort rounds, bedside nursing change of shift report, 2hr reassessment of all patients waiting for treatment, a video displayed in the waiting room with repeating information about patient visit expectations and patient acuity and flow process, grease boards in each room with the patient's caregivers' names listed, nurse eats - patient eats, administrative rounding, standing orders, real time patient satisfaction surveying at the point of care that includes service recovery if needed, MD disposition within 2.5hrs of arrival, MDs discharging patients, &quot;Dot &amp; Plot&quot; charge nurses tracking and reporting to staff at shift change the number of patients seen, admitted, and LWBS, charge nurse and physician rounding, and phoning treated and released patients back within 24 hours of discharge by the emergency medicine physicians. <br/><br/>Results/Outcomes: From 08 October through 09 December patient satisfaction scores rose by 12% (77.3 to 86.6), LWBS rate decreased by 9% (12.5 % to 3.5%), ED average length of stay decreased by 1.5 hours (6.4 to 4.9hrs). Closer analysis demonstrates an 18 % increase in ED volume from 08 July through 09 December. The most effective strategy that impacted ED throughput and patient satisfaction was the implementation of the staff led Core Teams. These teams have created an ED culture of service excellence and performance improvement. This overwhelming leadership by front line staff has motivated physicians and nurses to accept the ownership for process improvement. <br/><br/>Implications: To sustain a culture of performance improvement, strategies to impact ED throughput and patient satisfaction need to be led and facilitated by bedside clinicians and validated by performance data, staff and the patient. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:07Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:07Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.