2.50
Hdl Handle:
http://hdl.handle.net/10755/162560
Type:
Presentation
Title:
Interdisciplinary Collaboration: Decreasing Door-to-Discharge Times
Abstract:
Interdisciplinary Collaboration: Decreasing Door-to-Discharge Times
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Bigowsky, Mary Jo, RN, MSN, NAA-BC
P.I. Institution Name:St. Elizabeth Health Center
Title:Director Nursing
Contact Address:1044 Belmont Avenue, Youngstown, OH, 44501, USA
Contact Telephone:330-480-3853
Leadership Conference - Evidence-Based Practice Abstract: Interdisciplinary Collaboration: Decreasing Door to Discharge Time


Purpose: The purpose of our team was to decrease ED LOS for triage acuity level 4 and 5. Since 40% of patients who present to our ED arrive by ambulance, patients who walk in and present less acute are given a lesser priority to be seen by the physician resulting in a longer than acceptable LOS.

Design: Interdisciplinary team employed Lean Six Sigma methodology to evaluate and improve ED LOS for triage level 4 and 5 patients.

Setting: Urban, tertiary care, level one trauma and academic center, located in northeastern Ohio with 40,000 patient visits per year.

Participants: Patients presenting to the ED and triaged at acuity level 4 and 5.

Methods: Lean Six Sigma methodology was employed to evaluate and decrease the LOS for triage level 4 and 5 patients. An interdisciplinary performance improvement team was established and led through the DMAIC process to: Define the problem, Measure the current performance, Analyze the processes, Improve the processes, and Control the gains.

Results/Outcomes: Statistically significant reductions in LOS resulted from analyzing and improving key processes impacting ED LOS. Improvements focused on eliminating waste and reducing variation. Supplies and equipment were standardized resulting in decreased time staff spent hunting and gathering necessary supplies. Laboratory, Patient Transport, and Environmental Services hours of coverage were analyzed and compared to ED volumes. Services were aligned to match peak ED volumes. The satellite stat lab remained open during staff lunch breaks, replacing the prior practice of closing the stat lab and sending the specimens to the main laboratory for processing. This improvement allowed for more rapid turn around time of test results. A dedicated patient transporter was assigned to the ED during peak hours resulting in a decrease in ED staffÆs transport of patients to testing areas.

Our current "fast track" was redesigned and provided for the segregation of lower acuity patients. Physician staffing was modified so a specific practitioner had primary responsibility for acuity level 4 and 5 patients. Protocols and medications were standardized. Hours of operation were expanded to match the peak times of patient presentation to the ED. Staffing levels and staff roles and responsibilities were clearly defined. The addition of recliner chairs enhanced patient flow and increase capacity.

Results: Average LOS for both level 4 and level 5 patients decreased 63 minutes and 61 minutes as compared to baseline. This reduction was statistically significant as measured by the Two-tailed Test. In addition, the average LOS in the ED for admitted patients decreased by 195 minutes reflecting an improved ED LOS for all patients. This has been sustained for the past 6 months.

Implications: Overcrowding is a concern faced by hospitals across the county resulting in increased LWOT, long ED waits and the potential of adverse events. It is crucial that ED throughput is maintained. This team demonstrated that significant improvements in ED throughput are accomplished through interdisciplinary collaboration and teamwork.



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.titleInterdisciplinary Collaboration: Decreasing Door-to-Discharge Timesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162560-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Interdisciplinary Collaboration: Decreasing Door-to-Discharge Times</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">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Bigowsky, Mary Jo, RN, MSN, NAA-BC</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">St. Elizabeth Health Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1044 Belmont Avenue, Youngstown, OH, 44501, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">330-480-3853</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mary_bigowsky@hmis.org</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Evidence-Based Practice Abstract: Interdisciplinary Collaboration: Decreasing Door to Discharge Time<br/><br/><br/>Purpose: The purpose of our team was to decrease ED LOS for triage acuity level 4 and 5. Since 40% of patients who present to our ED arrive by ambulance, patients who walk in and present less acute are given a lesser priority to be seen by the physician resulting in a longer than acceptable LOS.<br/><br/>Design: Interdisciplinary team employed Lean Six Sigma methodology to evaluate and improve ED LOS for triage level 4 and 5 patients. <br/><br/>Setting: Urban, tertiary care, level one trauma and academic center, located in northeastern Ohio with 40,000 patient visits per year. <br/><br/>Participants: Patients presenting to the ED and triaged at acuity level 4 and 5. <br/><br/>Methods: Lean Six Sigma methodology was employed to evaluate and decrease the LOS for triage level 4 and 5 patients. An interdisciplinary performance improvement team was established and led through the DMAIC process to: Define the problem, Measure the current performance, Analyze the processes, Improve the processes, and Control the gains. <br/><br/>Results/Outcomes: Statistically significant reductions in LOS resulted from analyzing and improving key processes impacting ED LOS. Improvements focused on eliminating waste and reducing variation. Supplies and equipment were standardized resulting in decreased time staff spent hunting and gathering necessary supplies. Laboratory, Patient Transport, and Environmental Services hours of coverage were analyzed and compared to ED volumes. Services were aligned to match peak ED volumes. The satellite stat lab remained open during staff lunch breaks, replacing the prior practice of closing the stat lab and sending the specimens to the main laboratory for processing. This improvement allowed for more rapid turn around time of test results. A dedicated patient transporter was assigned to the ED during peak hours resulting in a decrease in ED staff&AElig;s transport of patients to testing areas. <br/><br/>Our current &quot;fast track&quot; was redesigned and provided for the segregation of lower acuity patients. Physician staffing was modified so a specific practitioner had primary responsibility for acuity level 4 and 5 patients. Protocols and medications were standardized. Hours of operation were expanded to match the peak times of patient presentation to the ED. Staffing levels and staff roles and responsibilities were clearly defined. The addition of recliner chairs enhanced patient flow and increase capacity. <br/><br/>Results: Average LOS for both level 4 and level 5 patients decreased 63 minutes and 61 minutes as compared to baseline. This reduction was statistically significant as measured by the Two-tailed Test. In addition, the average LOS in the ED for admitted patients decreased by 195 minutes reflecting an improved ED LOS for all patients. This has been sustained for the past 6 months. <br/><br/>Implications: Overcrowding is a concern faced by hospitals across the county resulting in increased LWOT, long ED waits and the potential of adverse events. It is crucial that ED throughput is maintained. This team demonstrated that significant improvements in ED throughput are accomplished through interdisciplinary collaboration and teamwork. <br/><br/><br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:15Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:15Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.