2.50
Hdl Handle:
http://hdl.handle.net/10755/162399
Type:
Presentation
Title:
Inward, Upward, Outward: Clearing the Path, Improving ED Patient Flow
Abstract:
Inward, Upward, Outward: Clearing the Path, Improving ED Patient Flow
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Pettis, Tamara, RN, BSN
P.I. Institution Name:Yakima Valley Memorial Hospital
Title:Trauma Coordinator, ED Staff RN
Contact Address:2811 Tieton Drive, Yakima, WA, 98902, USA
Contact Telephone:509-249-5216
[ENA Annual Conference - Evidence-based Practice Presentation]
Purpose: The increase in people using the Emergency Department as their Primary Care Provider has an effect on the ability to provide the most efficient patient care. Inefficient processes contribute to long wait times resulting in patient and provider frustration. The purpose of this project was to decrease patient wait times, smooth workflow, find and remove bottlenecks, decrease length of stay in the ED, and decrease the left without being seen (LWBS) rate.

Design: A new staff developed ED model of care and Q-Plus quality assurance programs were utilized.

Setting: 226 bed level 3 trauma designation facility located in Central Washington. The main Emergency Department has 24 beds; the Annex includes 9 non-urgent rooms. The annual Emergency Department census is 78,002.

Participants: To establish a baseline, 90 days worth of data for total ED visits was obtained, which included all patients presenting to the ED from January - March 2008.

Methods: Changes to our current model included:
1. Having a Provider assigned to each zone.
2. Adding a second nursesÆ station, decreasing the physical burden on nursing staff. Our previous practice involved patients waiting for an available RN to come to the waiting area to escort the patient to a room, to the triage RN calling an ED technician to bring the patient back to any available room.
3. Personal communication devices were given to each staff member allowing for more effective communication.
4. Annex hours were extended according to peak patient times.

Upon starting the Q-Plus project, two teams were formed, including personnel from ED and ancillary staff impacted by ED census. One team evaluated arrival time to Physician disposition, another team evaluated time from Provider disposition to discharge of the patient from the ED. Rapid cycle tests (RCT) were performed each time processes were implemented. Including:
1. ED Tech escorts patient to room, complete EKG if instructed.
2. Designated chart racks in each zone for new patients, reassessments, orders, and discharges.
3. MD notifies RN when patient is ready for discharge via Vocera, RN shall call report within 15 min. to Medical / Surgical Units.
4. Delegate discharges to a team member or to the Shift Coordinator when needed.
5. Additional RN Protocols implemented.
6. ED newsletter (RCT Education).

Results/Outcomes: Baseline data from January-March 2008 (17,422 patients) was compared to January-March 2009 (19,144 patients). Final data collected for May 2009 (6194 patients) showed a decrease of 17.67 minutes in Greet/Triage to MD evaluation, 8.33 minutes in MD to disposition, 1 minute in disposition to discharge or admit, and 28 minutes in average LOS. Data collected for LWBS patients decreased from 1.69% to 0.85%.

Implications: Although increases in patient census are experienced in the ED setting, this doesn't have to mean longer patient lines and wait times. By involving staff in workflow design, breaking down processes to make them more manageable and performing rapid cycle tests, great strides can be accomplished for providing the most efficient patient care.



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.titleInward, Upward, Outward: Clearing the Path, Improving ED Patient Flowen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162399-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Inward, Upward, Outward: Clearing the Path, Improving ED Patient Flow</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">Pettis, Tamara, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Yakima Valley Memorial Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Trauma Coordinator, ED Staff RN</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2811 Tieton Drive, Yakima, WA, 98902, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">509-249-5216</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">TamaraPettis@yvmh.org</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/>Purpose: The increase in people using the Emergency Department as their Primary Care Provider has an effect on the ability to provide the most efficient patient care. Inefficient processes contribute to long wait times resulting in patient and provider frustration. The purpose of this project was to decrease patient wait times, smooth workflow, find and remove bottlenecks, decrease length of stay in the ED, and decrease the left without being seen (LWBS) rate.<br/><br/>Design: A new staff developed ED model of care and Q-Plus quality assurance programs were utilized.<br/><br/>Setting: 226 bed level 3 trauma designation facility located in Central Washington. The main Emergency Department has 24 beds; the Annex includes 9 non-urgent rooms. The annual Emergency Department census is 78,002.<br/><br/>Participants: To establish a baseline, 90 days worth of data for total ED visits was obtained, which included all patients presenting to the ED from January - March 2008.<br/><br/>Methods: Changes to our current model included:<br/>1. Having a Provider assigned to each zone.<br/>2. Adding a second nurses&AElig; station, decreasing the physical burden on nursing staff. Our previous practice involved patients waiting for an available RN to come to the waiting area to escort the patient to a room, to the triage RN calling an ED technician to bring the patient back to any available room.<br/>3. Personal communication devices were given to each staff member allowing for more effective communication. <br/>4. Annex hours were extended according to peak patient times.<br/><br/>Upon starting the Q-Plus project, two teams were formed, including personnel from ED and ancillary staff impacted by ED census. One team evaluated arrival time to Physician disposition, another team evaluated time from Provider disposition to discharge of the patient from the ED. Rapid cycle tests (RCT) were performed each time processes were implemented. Including: <br/>1. ED Tech escorts patient to room, complete EKG if instructed.<br/>2. Designated chart racks in each zone for new patients, reassessments, orders, and discharges.<br/>3. MD notifies RN when patient is ready for discharge via Vocera, RN shall call report within 15 min. to Medical / Surgical Units. <br/>4. Delegate discharges to a team member or to the Shift Coordinator when needed.<br/>5. Additional RN Protocols implemented.<br/>6. ED newsletter (RCT Education).<br/><br/>Results/Outcomes: Baseline data from January-March 2008 (17,422 patients) was compared to January-March 2009 (19,144 patients). Final data collected for May 2009 (6194 patients) showed a decrease of 17.67 minutes in Greet/Triage to MD evaluation, 8.33 minutes in MD to disposition, 1 minute in disposition to discharge or admit, and 28 minutes in average LOS. Data collected for LWBS patients decreased from 1.69% to 0.85%.<br/><br/>Implications: Although increases in patient census are experienced in the ED setting, this doesn't have to mean longer patient lines and wait times. By involving staff in workflow design, breaking down processes to make them more manageable and performing rapid cycle tests, great strides can be accomplished for providing the most efficient patient care.<br/><br/><br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:33Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:33Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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