2.50
Hdl Handle:
http://hdl.handle.net/10755/162423
Type:
Presentation
Title:
Decreasing EMS Diversion in a Community Hospital Emergency Department
Abstract:
Decreasing EMS Diversion in a Community Hospital Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2011
Author:Chandler, Christina, RN, BSN, CEN
P.I. Institution Name:Mt. Carmel St. Ann's Hospital
Title:Clinical Manager
Contact Address:500 S. Cleveland Ave., Westerville, OH, 43081, USA
Contact Telephone:614-898-8585
[ENA Leadership Conference] Evidence-based Practice Presentation: Decreasing EMS Diversion in a Community Hospital Emergency Department

Purpose: Prior to June, 2006, when Emergency Department (ED) leadership began reviewing Emergency Medical Service (EMS) diversions, a formalized process for determining when to go on diversion did not exist. Monthly EMS diversion times sometimes exceeded one hundred hours a month. This resulted in patient, physician, and EMS dissatisfaction as well as lost revenue. The project intended to standardize the diversion decision making process and decrease hours on diversion.

Design: By implementing leadership review of diversion data sheets in June 2006, diversion hours decreased, but the process was still subjective. In March, 2009, a diversion committee formed including a physician, ED leadership, ED charge nurses, administrative supervisors, and in-patient unit directors. Lean methodology identified obstacles and processes which decreased the hours further.

Setting: The project developed in a community hospital ED, non-trauma designated, in suburban Columbus, Ohio.

Participants: ED charge nurses and local EMS providers are the primary decision makers and participants.

Methods: The committee used lean methodology to review current obstacles and processes and to develop hospital wide participation in the diversion processes. Literature review revealed the National Emergency Department Overcrowding Scale (NEDOCS) tool for standardizing the concept of "overcrowded."

Results: The project resulted in new processes. The diversion data sheet changed to reflect new data points. NEDOCS became the overcrowding tool in the department and became one of six steps to implement prior to going on EMS diversion. The ED charge nurse and ED physicians collaborate on diversion decisions. ED leadership and office staff respond to the unit to work as staff prior to diversion. Staff led suggestions streamlined discharge processes for non-admitted patients. A daily scorecard goes to hospital administration with volume statistics. In-patient processes include more efficient assigning of admission beds, housekeeping supervisors attending twice daily bed huddles, and increased charge nurse to charge nurse communication. With these processes implemented, metrics showed improvement. Diversion hours, EMS volumes, and boarded admission hours showed positive trends with the yearly ED census increasing. From FY 2006 to FY 2010, the diversion hours decreased from 740 to 187, the total number of EMS patients seen in the department increased from 9,572 to 10,590 with EMS admissions rising from 4,348 to 5,346. The yearly census increased from 72,293 to 74,921 with boarded admission hours decreasing from 4,311 to 960.

Implications: EMS diversion is an area of focus for EDs across the country. Implementing a standardized process decreased the instances and length of diversion. The new processes resulted in a standardized tool to determine overcrowding status in the ED, more review of admission processes to decrease boarded admission hours in the ED, and patients coming to the hospital of choice.
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.titleDecreasing EMS Diversion in a Community Hospital Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162423-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Decreasing EMS Diversion in a Community Hospital Emergency Department</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">2011</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Chandler, Christina, RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Mt. Carmel St. Ann's Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">500 S. Cleveland Ave., Westerville, OH, 43081, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">614-898-8585</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">cchandler@mchs.com</td></tr><tr><td colspan="2" class="item-abstract">[ENA Leadership Conference] Evidence-based Practice Presentation: Decreasing EMS Diversion in a Community Hospital Emergency Department<br/><br/>Purpose: Prior to June, 2006, when Emergency Department (ED) leadership began reviewing Emergency Medical Service (EMS) diversions, a formalized process for determining when to go on diversion did not exist. Monthly EMS diversion times sometimes exceeded one hundred hours a month. This resulted in patient, physician, and EMS dissatisfaction as well as lost revenue. The project intended to standardize the diversion decision making process and decrease hours on diversion. <br/><br/>Design: By implementing leadership review of diversion data sheets in June 2006, diversion hours decreased, but the process was still subjective. In March, 2009, a diversion committee formed including a physician, ED leadership, ED charge nurses, administrative supervisors, and in-patient unit directors. Lean methodology identified obstacles and processes which decreased the hours further. <br/><br/>Setting: The project developed in a community hospital ED, non-trauma designated, in suburban Columbus, Ohio.<br/><br/>Participants: ED charge nurses and local EMS providers are the primary decision makers and participants.<br/><br/>Methods: The committee used lean methodology to review current obstacles and processes and to develop hospital wide participation in the diversion processes. Literature review revealed the National Emergency Department Overcrowding Scale (NEDOCS) tool for standardizing the concept of &quot;overcrowded.&quot;<br/><br/>Results: The project resulted in new processes. The diversion data sheet changed to reflect new data points. NEDOCS became the overcrowding tool in the department and became one of six steps to implement prior to going on EMS diversion. The ED charge nurse and ED physicians collaborate on diversion decisions. ED leadership and office staff respond to the unit to work as staff prior to diversion. Staff led suggestions streamlined discharge processes for non-admitted patients. A daily scorecard goes to hospital administration with volume statistics. In-patient processes include more efficient assigning of admission beds, housekeeping supervisors attending twice daily bed huddles, and increased charge nurse to charge nurse communication. With these processes implemented, metrics showed improvement. Diversion hours, EMS volumes, and boarded admission hours showed positive trends with the yearly ED census increasing. From FY 2006 to FY 2010, the diversion hours decreased from 740 to 187, the total number of EMS patients seen in the department increased from 9,572 to 10,590 with EMS admissions rising from 4,348 to 5,346. The yearly census increased from 72,293 to 74,921 with boarded admission hours decreasing from 4,311 to 960.<br/><br/>Implications: EMS diversion is an area of focus for EDs across the country. Implementing a standardized process decreased the instances and length of diversion. The new processes resulted in a standardized tool to determine overcrowding status in the ED, more review of admission processes to decrease boarded admission hours in the ED, and patients coming to the hospital of choice.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:58Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:58Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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