2.50
Hdl Handle:
http://hdl.handle.net/10755/162684
Type:
Presentation
Title:
Flow Initiative Rapid Assessment Zone
Abstract:
Flow Initiative Rapid Assessment Zone
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Cadigan, Janet, RN, BA
P.I. Institution Name:The Credit Valley Hospital
Title:Nurse Manager, Emergency Department
Contact Address:, Mississauga, Ontario, L5M 2N1, Canada
Contact Telephone:(905) 813-1100
Co-Authors:Janice Whitford, RN, BScN, ENC, ACLS, TNCC, ENPC; Jane Scigliano, RN
Purpose: Managing patient throughput and system factors associated with emergency department wait times were the primary focus of this Six Sigma initiative to evaluate efficiency of processing triage level III patients.

Design: A partnership with 3M facilitated Six Sigma process mapping, root cause and statistical analysis to identify delays in patient processes.

Setting: This 40-bed community emergency department sees 70,000 annual visits and serves a culturally diverse population and 30% pediatric population. Triage level III patients comprise approximately 50% of patient volume.

Subjects: All comers triaged as level III by Canadian Triage and Acuity Scale recommendations.

Methods: The project began in June 2005. Multidisciplinary and champion review members were identified. "Process watchers" collected data over three weeks. Statistical analysis showed bed lag assignment, physician first assessment, order entry to diagnostics and physician reassessment to be the process times critical to reducing the overall emergency length of stay. Results were shared at various forums to gain stakeholder support. Extensive literature reviews, site visits and team discussion occurred during the planning stage. Results were used to redesign the process from a sequential to a parallel processing approach. Pilot testing was done to ensure that change had a direct effect on outcomes. A new rapid assessment zone (RAZ) for triage level III patients was implemented in March 2006. Numerous patients move through this zone simultaneously and do not need a specified bed location to facilitate assessment and reassessment. This reduced the problem of stretcher capacity.

Results: Initially, this change alone did not reduce overall length of stay. The physicians' schedule was adjusted to resolve gaps in physician RAZ coverage. A permanent RAZ nursing team leader was assigned for rigor in process. The project was closed September 2006 after achieving a decrease in length of stay for triage level III patients. Comparing the first and last quarters of 2006 demonstrated improvement in length of stay from 315 to 277 minutes, left without being seen rates from 9.5% to 5.2% and triage to physician assessment from 169 to 137 minutes. Indicators reflect a consistent downward trend despite an annual 10% increase in patient volumes and high rates of no bed admissions. Patient satisfaction scores are improving with Access and Coordination and Overall Satisfaction rates increasing from 55.5% to 57.4% and 71.6% to 76.5% respectively over the same period.

Recommendations: Continue to monitor quality and utilization indicators for sustainability. Apply the principles learned through this project to improve discharge processes and workflow around "no bed admissions."
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.titleFlow Initiative Rapid Assessment Zoneen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162684-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Flow Initiative Rapid Assessment Zone</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">Cadigan, Janet, RN, BA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The Credit Valley Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Manager, Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Mississauga, Ontario, L5M 2N1, Canada</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(905) 813-1100</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jcadigan@cvh.on.ca</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Janice Whitford, RN, BScN, ENC, ACLS, TNCC, ENPC; Jane Scigliano, RN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Managing patient throughput and system factors associated with emergency department wait times were the primary focus of this Six Sigma initiative to evaluate efficiency of processing triage level III patients.<br/><br/>Design: A partnership with 3M facilitated Six Sigma process mapping, root cause and statistical analysis to identify delays in patient processes.<br/><br/>Setting: This 40-bed community emergency department sees 70,000 annual visits and serves a culturally diverse population and 30% pediatric population. Triage level III patients comprise approximately 50% of patient volume.<br/><br/>Subjects: All comers triaged as level III by Canadian Triage and Acuity Scale recommendations.<br/><br/>Methods: The project began in June 2005. Multidisciplinary and champion review members were identified. &quot;Process watchers&quot; collected data over three weeks. Statistical analysis showed bed lag assignment, physician first assessment, order entry to diagnostics and physician reassessment to be the process times critical to reducing the overall emergency length of stay. Results were shared at various forums to gain stakeholder support. Extensive literature reviews, site visits and team discussion occurred during the planning stage. Results were used to redesign the process from a sequential to a parallel processing approach. Pilot testing was done to ensure that change had a direct effect on outcomes. A new rapid assessment zone (RAZ) for triage level III patients was implemented in March 2006. Numerous patients move through this zone simultaneously and do not need a specified bed location to facilitate assessment and reassessment. This reduced the problem of stretcher capacity.<br/><br/>Results: Initially, this change alone did not reduce overall length of stay. The physicians' schedule was adjusted to resolve gaps in physician RAZ coverage. A permanent RAZ nursing team leader was assigned for rigor in process. The project was closed September 2006 after achieving a decrease in length of stay for triage level III patients. Comparing the first and last quarters of 2006 demonstrated improvement in length of stay from 315 to 277 minutes, left without being seen rates from 9.5% to 5.2% and triage to physician assessment from 169 to 137 minutes. Indicators reflect a consistent downward trend despite an annual 10% increase in patient volumes and high rates of no bed admissions. Patient satisfaction scores are improving with Access and Coordination and Overall Satisfaction rates increasing from 55.5% to 57.4% and 71.6% to 76.5% respectively over the same period.<br/><br/>Recommendations: Continue to monitor quality and utilization indicators for sustainability. Apply the principles learned through this project to improve discharge processes and workflow around &quot;no bed admissions.&quot;</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:24Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:24Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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