Improving Patient Flow Between Emergency Department and General Internal Medicine

2.50
Hdl Handle:
http://hdl.handle.net/10755/162463
Type:
Presentation
Title:
Improving Patient Flow Between Emergency Department and General Internal Medicine
Abstract:
Improving Patient Flow Between Emergency Department and General Internal Medicine
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Woollard, Susan, BA, RN, MAEd, ENC(c), CHE
P.I. Institution Name:North York General Hospital
Title:Program Director, Emergency Services Program
Contact Address:, Toronto, Ontario, M2K 1E1, Canada
Contact Telephone:(416) 756-6150
Co-Authors:Karyn Popovich, RN, ENC, MHS, CHE
Purpose: Patient flow was identified as the Hospital's number one priority through a corporate quality planning process to improve the overall patient experience. It was recognized that to improve flow from the ED to GIM, it would require a change in the organization's culture and infrastructure to support working across traditional department/unit barriers to develop an overall system of flow.

Design: This quality management project uses Lean methodology and Lean tools to create and manage flow within the ED and GIM. Value stream mapping, an analysis tool was used to develop and understand the current state, to develop a vision for perfection, and create a realistic future state map to show the next step in the improvement journey. From the Future State map, a detailed action plan of events (Kaizen?s), projects, and "do-it's" was designed. Key measures were developed and tracked against goals.

Setting: ED and two GIM units, within a 400 bed community teaching hospital.

Participants/Subjects: Clinical Manager's, Program Directors, Physicians, nursing staff and allied health practitioners from both the ED and GIM units.

Methods: Interventions to achieve excellence within ED and GIM focused on access to care, wait times, patient flow, and quality of care. Primary indicators included metrics such as ED wait time, admission to GIM wait time, GIM LOS, Ambulance off-load times, and patient and staff satisfaction. Specific goals of interventions include improved service coordination, service availability and capacity.

The first opportunity for improvement was the patient transfer process from ED to a GIM inpatient bed. The reason for choosing this process for improvement was a standard process for transferring patients to an inpatient bed did not exist, the number of hours patients spent in the ED after a bed assigned was too high, there was no clear visibility around the status of beds assigned and the nurse to nurse report system utilized when transferring patients did not meet the needs of the receiving staff. The second opportunity for improvement was the discharge process in GIM. The reason for choosing this process for improvement was the discharge of patients was complex and uncoordinated and did not facilitate timely admissions from the ED.
It was decided to address these opportunities using a Kaizen event.

Results: Double digit metric improvements have been achieved in both projects.

Recommendations: Process owners (leaders) of these events are important catalysts to effect change both at the local level and corporate level. Having both ED and GIM leaders (including physicians) lead these events have absolutely facilitated their success.
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 Flow Between Emergency Department and General Internal Medicineen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162463-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Patient Flow Between Emergency Department and General Internal Medicine</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">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Woollard, Susan, BA, RN, MAEd, ENC(c), CHE</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">North York General Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Program Director, Emergency Services Program</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Toronto, Ontario, M2K 1E1, Canada</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(416) 756-6150</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">swoollar@nygh.on.ca</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Karyn Popovich, RN, ENC, MHS, CHE</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Patient flow was identified as the Hospital's number one priority through a corporate quality planning process to improve the overall patient experience. It was recognized that to improve flow from the ED to GIM, it would require a change in the organization's culture and infrastructure to support working across traditional department/unit barriers to develop an overall system of flow. <br/><br/>Design: This quality management project uses Lean methodology and Lean tools to create and manage flow within the ED and GIM. Value stream mapping, an analysis tool was used to develop and understand the current state, to develop a vision for perfection, and create a realistic future state map to show the next step in the improvement journey. From the Future State map, a detailed action plan of events (Kaizen?s), projects, and &quot;do-it's&quot; was designed. Key measures were developed and tracked against goals.<br/><br/>Setting: ED and two GIM units, within a 400 bed community teaching hospital. <br/><br/>Participants/Subjects: Clinical Manager's, Program Directors, Physicians, nursing staff and allied health practitioners from both the ED and GIM units.<br/><br/> Methods: Interventions to achieve excellence within ED and GIM focused on access to care, wait times, patient flow, and quality of care. Primary indicators included metrics such as ED wait time, admission to GIM wait time, GIM LOS, Ambulance off-load times, and patient and staff satisfaction. Specific goals of interventions include improved service coordination, service availability and capacity. <br/><br/>The first opportunity for improvement was the patient transfer process from ED to a GIM inpatient bed. The reason for choosing this process for improvement was a standard process for transferring patients to an inpatient bed did not exist, the number of hours patients spent in the ED after a bed assigned was too high, there was no clear visibility around the status of beds assigned and the nurse to nurse report system utilized when transferring patients did not meet the needs of the receiving staff. The second opportunity for improvement was the discharge process in GIM. The reason for choosing this process for improvement was the discharge of patients was complex and uncoordinated and did not facilitate timely admissions from the ED.<br/>It was decided to address these opportunities using a Kaizen event.<br/><br/>Results: Double digit metric improvements have been achieved in both projects.<br/><br/>Recommendations: Process owners (leaders) of these events are important catalysts to effect change both at the local level and corporate level. Having both ED and GIM leaders (including physicians) lead these events have absolutely facilitated their success.</td></tr></table>en_GB
dc.date.available2011-10-27T10:28:38Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:38Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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