2.50
Hdl Handle:
http://hdl.handle.net/10755/162434
Type:
Presentation
Title:
Commitment to Excellence: Surge to Improve Satisfaction
Abstract:
Commitment to Excellence: Surge to Improve Satisfaction
Conference Sponsor:Emergency Nurses Association
Conference Year:2011
Author:McCalman, Christine, RN, MSN, CEN
P.I. Institution Name:Huntsville Hospital for Women and Children
Title:Nurse Manager
Contact Address:101 Sivley Road, Huntsville, AL, 35801, USA
Contact Telephone:256-265-7064
[ENA Leadership Conference] Evidence-based Practice Presentation: Commitment to Excellence: Surge to Improve Satisfaction

Purpose: The purpose of this evidenced-based project was to successfully develop a process decreasing time to provider in a busy pediatric emergency department (PED). The objective was to safely and efficiently manage the surge volume that predictably occurred each day without the addition of staff or facility expansion. Time to care has the strongest association with patient satisfaction. Attention to the mission and vision of the hospital was the foundation for change.

Design: This evidenced-based project was patterned after Titler's (2001) IOWA model and employed the use of Plan, Do, Check, Act methodology. The project encompassed quality assurance, patient satisfaction and revenue generating components. Management and staff determined that triage and patient flow needed to be revised for improvement of patient care and work-flow processes.

Setting: The project setting is a PED located in a large metropolitan area serving as a regional referral center. 35,000 children per year are treated in this 16 bed facility. The department is staffed by an all RN staff, board certified pediatric physicians and pediatricians.

Participants: Participants involved in the project were all patients presenting to the emergency department over a six month period.

Methods: Time to provider, length of stay, patient satisfaction and left without treatment (LWOT) are parameters measured in the PED. In December of 2009, influenza season hit hard. The system was taxed in ways never before experienced. Triage process and bed flow needed to be examined. A Surge committee was formed consisting of PED nurses and a physician leader. Decreasing length of stay from 160 to 120 minutes, lowering the LWOT rate to 1% and improving patient flow were targets. Benchmarks and guidelines were set for each identified process. Weekly meetings were scheduled at change of shift in an attempt to increase staff participation. Using the IOWA model, areas for improvement were identified. A process map was developed tracking door to bed, bed to physician and disposition to discharge. It was soon apparent that each process from triage to the environmental service component impacted the patient care experience. Challenging issues were triage and space to efficiently care for patients. The Surge group was expanded to include a representative from Information Technology, environmental services, security, pharmacy and registration. Time studies from door to discharge were performed and critically analyzed. IT examined the electronic medical record time stamp and registration identified a back-log at discharge. Radiology rooms utilized during day shift hours served as Surge rooms after 5pm. Criteria for placing patients in Surge beds were created using 5 level triage.

Results: LOS was decreased to 117 minutes and LWOT to .3% in 6 months. Patient satisfaction increased to 91%. The PDCA process resulted in a revised trige process. Patients meeting surge criteria were placed in surge beds even when the PED had available beds. Scheduling housekeeping and registration personnel based on surge volume improved throughput.

Implications: Surge plan success required evaluation of every care component from assigning triage codes, patient bed placement and nursing workflow. It took a team.
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.titleCommitment to Excellence: Surge to Improve Satisfactionen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162434-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Commitment to Excellence: Surge to Improve Satisfaction</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">McCalman, Christine, RN, MSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Huntsville Hospital for Women and Children</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">101 Sivley Road, Huntsville, AL, 35801, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">256-265-7064</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">chris.mccalman@hhsys.org</td></tr><tr><td colspan="2" class="item-abstract">[ENA Leadership Conference] Evidence-based Practice Presentation: Commitment to Excellence: Surge to Improve Satisfaction<br/><br/>Purpose: The purpose of this evidenced-based project was to successfully develop a process decreasing time to provider in a busy pediatric emergency department (PED). The objective was to safely and efficiently manage the surge volume that predictably occurred each day without the addition of staff or facility expansion. Time to care has the strongest association with patient satisfaction. Attention to the mission and vision of the hospital was the foundation for change.<br/><br/>Design: This evidenced-based project was patterned after Titler's (2001) IOWA model and employed the use of Plan, Do, Check, Act methodology. The project encompassed quality assurance, patient satisfaction and revenue generating components. Management and staff determined that triage and patient flow needed to be revised for improvement of patient care and work-flow processes.<br/><br/>Setting: The project setting is a PED located in a large metropolitan area serving as a regional referral center. 35,000 children per year are treated in this 16 bed facility. The department is staffed by an all RN staff, board certified pediatric physicians and pediatricians.<br/><br/>Participants: Participants involved in the project were all patients presenting to the emergency department over a six month period.<br/><br/>Methods: Time to provider, length of stay, patient satisfaction and left without treatment (LWOT) are parameters measured in the PED. In December of 2009, influenza season hit hard. The system was taxed in ways never before experienced. Triage process and bed flow needed to be examined. A Surge committee was formed consisting of PED nurses and a physician leader. Decreasing length of stay from 160 to 120 minutes, lowering the LWOT rate to 1% and improving patient flow were targets. Benchmarks and guidelines were set for each identified process. Weekly meetings were scheduled at change of shift in an attempt to increase staff participation. Using the IOWA model, areas for improvement were identified. A process map was developed tracking door to bed, bed to physician and disposition to discharge. It was soon apparent that each process from triage to the environmental service component impacted the patient care experience. Challenging issues were triage and space to efficiently care for patients. The Surge group was expanded to include a representative from Information Technology, environmental services, security, pharmacy and registration. Time studies from door to discharge were performed and critically analyzed. IT examined the electronic medical record time stamp and registration identified a back-log at discharge. Radiology rooms utilized during day shift hours served as Surge rooms after 5pm. Criteria for placing patients in Surge beds were created using 5 level triage. <br/><br/>Results: LOS was decreased to 117 minutes and LWOT to .3% in 6 months. Patient satisfaction increased to 91%. The PDCA process resulted in a revised trige process. Patients meeting surge criteria were placed in surge beds even when the PED had available beds. Scheduling housekeeping and registration personnel based on surge volume improved throughput. <br/><br/>Implications: Surge plan success required evaluation of every care component from assigning triage codes, patient bed placement and nursing workflow. It took a team.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:28:09Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:09Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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