2.50
Hdl Handle:
http://hdl.handle.net/10755/162408
Type:
Presentation
Title:
Shrinking the Crowd: "Decreasing Left without Being Seen" Patients
Abstract:
Shrinking the Crowd: "Decreasing Left without Being Seen" Patients
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Silverman, Mary Kay, RN, CEN
P.I. Institution Name:Hahnemann University Hospital
Title:Director of Emergency Services
Contact Address:Broad and Vine Streets, Philadelphia, PA, 19102, USA
Contact Telephone:215-762-7328
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: The organization became attentive to the issue of overcrowding in Emergency Departments (ED) and was determined to improve patient throughput and decrease the left without being seen (LWBS) rate. ED overcrowding is a hindrance leading to delays in patient care, patient flight prior to the completion of care, ambulance diversions, and a decrease in satisfaction scores.

Design: The study is an evidence-based concentrated initiative focused on quality improvement.

Setting: The project took place in an urban, academic, level 1 trauma center's Emergency Department. The organization has 540 licensed beds.

Participants/Subjects: Male and female adult patients ranging in age from 18 to 100+ are the typical patient population flowing through the ED. Level I and level II trauma patients were excluded from the LWBS data.

Methods: The initiatives began with implementing a "right-back" practice. This structure immediately moves patients to any open bed within the ED, allowing continuous flow from the triage area to an ED room. The next step involved changing the triage system from the classification of "stable, urgent, emergent" to the Emergency Nurses Association supported 5 Level Emergency Severity Index (ESI) triaging system. The ESI triage approach identifies more Fast Track (acute, but non-life threatening) patients, a level 4 and 5 on the ESI Index, at a more advanced pace. The ESI system identified Fast Track patients as the typical LWBS population. This led to the improvement of the Fast Track Program to support decreasing the LWBS rate: a second nurse practitioner was hired, the program increased from 6 to 7 days per week, and a RN is present to provide support. Physician collaboration and support was a must. The physicians were required to determine a disposition (admission to an in-patient unit, transfer to another facility, or discharge) for the patient within 4 hours of assessment. Part of the successful change involved empowering nursing staff to monitor physicians for patient disposition. Nursing is attentive to education and results via staff meetings and voice suggestions for change in a shared governance forum. The LWBS percentage is obtained by a report through Medhost and is evaluated on a daily and monthly basis.

Results/Outcomes: The undeniable impact of the initiatives can be seen in the reduced LWBS rate. After 12 months of implementation, December 2008 to December 2009, LWBS decreased from 14% in 2008 to 7% in 2009. Staff commitment to the process change has led to a precipitous drop in the ED diversion rate from 900 hours in 2008 to 4 hours in 2009.

Implications: A compelling issue was identified that had the commitment of those closest to the problem to own it - a dedicated team of nurses and physicians with support from leadership û and a systematic plan that included evidence-based ideas was put into place. The quantitative results demonstrate the tremendous success of this innovation. More importantly, the success of the team in doing right by the patients reasserts the fact that a focus on quality provides optimal patient care leading to best patient outcomes.
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.titleShrinking the Crowd: "Decreasing Left without Being Seen" Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162408-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Shrinking the Crowd: &quot;Decreasing Left without Being Seen&quot; Patients</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">Silverman, Mary Kay, RN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Hahnemann University Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director of Emergency Services</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Broad and Vine Streets, Philadelphia, PA, 19102, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">215-762-7328</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">marykay.silverman@tenethealth.com</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation]<br/><br/>Purpose: The organization became attentive to the issue of overcrowding in Emergency Departments (ED) and was determined to improve patient throughput and decrease the left without being seen (LWBS) rate. ED overcrowding is a hindrance leading to delays in patient care, patient flight prior to the completion of care, ambulance diversions, and a decrease in satisfaction scores.<br/><br/>Design: The study is an evidence-based concentrated initiative focused on quality improvement.<br/><br/>Setting: The project took place in an urban, academic, level 1 trauma center's Emergency Department. The organization has 540 licensed beds. <br/><br/>Participants/Subjects: Male and female adult patients ranging in age from 18 to 100+ are the typical patient population flowing through the ED. Level I and level II trauma patients were excluded from the LWBS data. <br/><br/>Methods: The initiatives began with implementing a &quot;right-back&quot; practice. This structure immediately moves patients to any open bed within the ED, allowing continuous flow from the triage area to an ED room. The next step involved changing the triage system from the classification of &quot;stable, urgent, emergent&quot; to the Emergency Nurses Association supported 5 Level Emergency Severity Index (ESI) triaging system. The ESI triage approach identifies more Fast Track (acute, but non-life threatening) patients, a level 4 and 5 on the ESI Index, at a more advanced pace. The ESI system identified Fast Track patients as the typical LWBS population. This led to the improvement of the Fast Track Program to support decreasing the LWBS rate: a second nurse practitioner was hired, the program increased from 6 to 7 days per week, and a RN is present to provide support. Physician collaboration and support was a must. The physicians were required to determine a disposition (admission to an in-patient unit, transfer to another facility, or discharge) for the patient within 4 hours of assessment. Part of the successful change involved empowering nursing staff to monitor physicians for patient disposition. Nursing is attentive to education and results via staff meetings and voice suggestions for change in a shared governance forum. The LWBS percentage is obtained by a report through Medhost and is evaluated on a daily and monthly basis. <br/><br/>Results/Outcomes: The undeniable impact of the initiatives can be seen in the reduced LWBS rate. After 12 months of implementation, December 2008 to December 2009, LWBS decreased from 14% in 2008 to 7% in 2009. Staff commitment to the process change has led to a precipitous drop in the ED diversion rate from 900 hours in 2008 to 4 hours in 2009.<br/><br/>Implications: A compelling issue was identified that had the commitment of those closest to the problem to own it - a dedicated team of nurses and physicians with support from leadership &ucirc; and a systematic plan that included evidence-based ideas was put into place. The quantitative results demonstrate the tremendous success of this innovation. More importantly, the success of the team in doing right by the patients reasserts the fact that a focus on quality provides optimal patient care leading to best patient outcomes. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:43Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:43Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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