2.50
Hdl Handle:
http://hdl.handle.net/10755/162490
Type:
Presentation
Title:
Splitting the ED to Improve Patient Throughput Produces Dramatic Results!
Abstract:
Splitting the ED to Improve Patient Throughput Produces Dramatic Results!
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Tozi, Kim, RN, CEN
P.I. Institution Name:Banner Baywood Medical Center
Title:ED Clinical Manager
Contact Address:6644 E. Baywood, Mesa, AZ, 85206, USA
Contact Telephone:480-981-4211
Co-Authors:Lynn Litwinowich, RN, MBA, MHSA; Ashley Bergeron, RN; and Anne Mitchell, MS, CEN, CCRN, APRN, CNS ED & ICU
[Clinical Poster] Clinical Topic: Overcrowding in our Emergency Department (ED) was a significant issue. Using a traditional ED process model, triage, acuity assignment, ED bed when available and physician exam regardless of acuity, performance measures were unacceptable. The time from patient arrival in ED to physician exam (door to doc time), ED length of stay, and the number of patients leaving without treatment (LWOT) had increased to intolerable levels. Patient satisfaction was in the bottom decile of performance.

In addition, nurses, besieged with acutely ill patients, were responsible for managing and reassessing them in the lobby for extended periods of time before they were placed in an ED bed and saw a physician. This process did not support safe patient care.

Implementation: A 33 member multi-disciplinary team of ED nurses, techs, physicians, and stakeholders from ancillary departments redesigned and implemented a new patient throughput process. The result was a split ED process model in which patients who are stable do not "own" a bed. Intake zones were developed with private rooms for exams and staffed with ED physicians, nurses, and techs. A results waiting area supplied with chairs was created for this zone.

In the Intake area, all patients except those with life-threatening conditions would be first seen by a Greet Nurse who determines stability, acuity and chief complaint. Unstable patients would be immediately sent to a bed in the main ED. Stable patients would be immediately placed in an "intake room", evaluated by the ED physician, and sent to the results waiting area. Once diagnostic results became available, stable patients would be discharged home or admitted without ever occupying a bed in the actual ED. Main ED beds would be readily available for true emergencies, and stable patients could be seen and dispositioned quickly with shorter wait times. The new processes were implemented on November 16, 2005.

Outcomes: The split model design with bed ownership only for acutely ill patients has been successful. When pre & post outcomes were compared, LWOTs decreased from 12.3% to 4.2%; door to doc times decreased from 3.8 to 1.1 hrs ; length of stay for treat & release patients decreased from 6.3 to 3.8 hrs; patient satisfaction climbed to the 70th percentile.

Recommendations: Split ED design with limited bed "ownership" could be considered as a potential successful solution for ED overcrowding, long ED wait times & high LWOT rates.
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.titleSplitting the ED to Improve Patient Throughput Produces Dramatic Results!en_GB
dc.identifier.urihttp://hdl.handle.net/10755/162490-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Splitting the ED to Improve Patient Throughput Produces Dramatic Results!</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">Tozi, Kim, RN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Banner Baywood Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">ED Clinical Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6644 E. Baywood, Mesa, AZ, 85206, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">480-981-4211</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kimtozi@cox.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Lynn Litwinowich, RN, MBA, MHSA; Ashley Bergeron, RN; and Anne Mitchell, MS, CEN, CCRN, APRN, CNS ED &amp; ICU</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Overcrowding in our Emergency Department (ED) was a significant issue. Using a traditional ED process model, triage, acuity assignment, ED bed when available and physician exam regardless of acuity, performance measures were unacceptable. The time from patient arrival in ED to physician exam (door to doc time), ED length of stay, and the number of patients leaving without treatment (LWOT) had increased to intolerable levels. Patient satisfaction was in the bottom decile of performance.<br/><br/>In addition, nurses, besieged with acutely ill patients, were responsible for managing and reassessing them in the lobby for extended periods of time before they were placed in an ED bed and saw a physician. This process did not support safe patient care. <br/><br/>Implementation: A 33 member multi-disciplinary team of ED nurses, techs, physicians, and stakeholders from ancillary departments redesigned and implemented a new patient throughput process. The result was a split ED process model in which patients who are stable do not &quot;own&quot; a bed. Intake zones were developed with private rooms for exams and staffed with ED physicians, nurses, and techs. A results waiting area supplied with chairs was created for this zone. <br/><br/>In the Intake area, all patients except those with life-threatening conditions would be first seen by a Greet Nurse who determines stability, acuity and chief complaint. Unstable patients would be immediately sent to a bed in the main ED. Stable patients would be immediately placed in an &quot;intake room&quot;, evaluated by the ED physician, and sent to the results waiting area. Once diagnostic results became available, stable patients would be discharged home or admitted without ever occupying a bed in the actual ED. Main ED beds would be readily available for true emergencies, and stable patients could be seen and dispositioned quickly with shorter wait times. The new processes were implemented on November 16, 2005. <br/><br/>Outcomes: The split model design with bed ownership only for acutely ill patients has been successful. When pre &amp; post outcomes were compared, LWOTs decreased from 12.3% to 4.2%; door to doc times decreased from 3.8 to 1.1 hrs ; length of stay for treat &amp; release patients decreased from 6.3 to 3.8 hrs; patient satisfaction climbed to the 70th percentile. <br/><br/>Recommendations: Split ED design with limited bed &quot;ownership&quot; could be considered as a potential successful solution for ED overcrowding, long ED wait times &amp; high LWOT rates.</td></tr></table>en_GB
dc.date.available2011-10-27T10:29:05Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:05Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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