2.50
Hdl Handle:
http://hdl.handle.net/10755/162480
Type:
Presentation
Title:
Implementation of an ED Throughput Model to Enhance Patient Flow
Abstract:
Implementation of an ED Throughput Model to Enhance Patient Flow
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Morgan, Barbara, RN, MSN, CNA
P.I. Institution Name:Cleveland Clinic
Title:Clinical Nursing Director, Emergency Services/Critical Care
Contact Address:9500 Euclid Avenue, E19, Cleveland, OH, 44195, USA
Contact Telephone:216-444-9262
Co-Authors:Nina M. Fielden, RN, MSN, CEN
[Clinical Poster] Clinical Topic: Overcrowding in emergency departments results from increasing needs for emergency services and hospital occupancy. Novel ways of meeting this increased need for emergency services without delaying care have been implemented in this Midwest urban tertiary referral hospital emergency department (ED), seeing 60,000 patients per year, with a 96% hospital occupancy.

Implementation: 1) ED leadership team and physicians/nurses from the quality improvement team (QI) undertook the goal of redesigning the triage system to keep the waiting room empty of patients and improve throughput in the ED. The Emergency Department is composed of different units: main ED for ESI category 1, 2, and 3 patients, fast track for category 3, 4 , and 5 patients, and clinical decision unit (CDU) for observation patients. With the new system, when beds are available, the patient bypasses the triage area: initial assessment, interventions, and registration are completed at the bedside. When beds are unavailable, the triage nurse performs the initial assessment and transfers the patient to the waiting room and/or registration if stable or notifies the charge nurse for a bed if the patient is not stable. 2) A new eight chair area, triage plus, was developed for ESI category 4 and 5 patients where registration and interventions per triage guideline could be initiated to expedite disposition for these less urgent patients. Triage guidelines also allow for tests to be initiated for category 3 patients in the triage area. 3) Assistant nurse managers on all shifts became throughput managers to facilitate the patient's progress to the appropriate unit in the ED and to disposition: CDU, admission, or discharge. Physician and nurse communication is maintained with the throughput managers to manage flow through the ED and appropriate disposition. 4) To reduce boarding times in this ED, arrangements were made with hospitals within the same system to accept admissions, reducing the time patients waited for a hospital bed.

Outcomes: Data was compared from 4th quarter 2006 to 1st quarter 2007. Time to physician decreased 22%, elopements decreased 42%, and time to decision for disposition decreased 10 minutes. Perception of care related to "no wait to room" improved from 90% to 94% and ôno wait to physicianö 91% to 96%. Ongoing data will be shared.

Recommendations: Reviewing throughput processes in the ED may decrease patient waiting times and increase patient satisfaction. Ongoing quality monitoring helps maintain throughput and suggests new improvements to the process.
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.titleImplementation of an ED Throughput Model to Enhance Patient Flowen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162480-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Implementation of an ED Throughput Model to Enhance 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">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Morgan, Barbara, RN, MSN, CNA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Cleveland Clinic</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nursing Director, Emergency Services/Critical Care</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9500 Euclid Avenue, E19, Cleveland, OH, 44195, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">216-444-9262</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">morganb@ccf.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Nina M. Fielden, RN, MSN, CEN</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Overcrowding in emergency departments results from increasing needs for emergency services and hospital occupancy. Novel ways of meeting this increased need for emergency services without delaying care have been implemented in this Midwest urban tertiary referral hospital emergency department (ED), seeing 60,000 patients per year, with a 96% hospital occupancy. <br/><br/>Implementation: 1) ED leadership team and physicians/nurses from the quality improvement team (QI) undertook the goal of redesigning the triage system to keep the waiting room empty of patients and improve throughput in the ED. The Emergency Department is composed of different units: main ED for ESI category 1, 2, and 3 patients, fast track for category 3, 4 , and 5 patients, and clinical decision unit (CDU) for observation patients. With the new system, when beds are available, the patient bypasses the triage area: initial assessment, interventions, and registration are completed at the bedside. When beds are unavailable, the triage nurse performs the initial assessment and transfers the patient to the waiting room and/or registration if stable or notifies the charge nurse for a bed if the patient is not stable. 2) A new eight chair area, triage plus, was developed for ESI category 4 and 5 patients where registration and interventions per triage guideline could be initiated to expedite disposition for these less urgent patients. Triage guidelines also allow for tests to be initiated for category 3 patients in the triage area. 3) Assistant nurse managers on all shifts became throughput managers to facilitate the patient's progress to the appropriate unit in the ED and to disposition: CDU, admission, or discharge. Physician and nurse communication is maintained with the throughput managers to manage flow through the ED and appropriate disposition. 4) To reduce boarding times in this ED, arrangements were made with hospitals within the same system to accept admissions, reducing the time patients waited for a hospital bed.<br/><br/>Outcomes: Data was compared from 4th quarter 2006 to 1st quarter 2007. Time to physician decreased 22%, elopements decreased 42%, and time to decision for disposition decreased 10 minutes. Perception of care related to &quot;no wait to room&quot; improved from 90% to 94% and &ocirc;no wait to physician&ouml; 91% to 96%. Ongoing data will be shared.<br/><br/>Recommendations: Reviewing throughput processes in the ED may decrease patient waiting times and increase patient satisfaction. Ongoing quality monitoring helps maintain throughput and suggests new improvements to the process.</td></tr></table>en_GB
dc.date.available2011-10-27T10:28:55Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:55Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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