2.50
Hdl Handle:
http://hdl.handle.net/10755/162686
Type:
Presentation
Title:
Safely Caring for More Patients - Faster - in a Busy ED
Abstract:
Safely Caring for More Patients - Faster - in a Busy ED
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Chang, Julia, RN, MSN
P.I. Institution Name:Brackenridge Hospital
Title:Sr. RN Project Coordinator, Staff Nurse
Contact Address:, Austin, TX, 78701-, USA
Contact Telephone:(512) 324-7000
Co-Authors:Daphne Wofford, RN, MSN; Clay Adam, RN, BSN, CEN; Mark Wilson, FNP; Ricky Ritchie, LVN; Shonna Tobias, RN, BSN; Felix McCoy, LVN; Patrick Crocker, DO; Michael Mouw, MD
Purpose: Nationally, emergency departments (ED) face overcrowding and increasing Left-Without-Being-Seen (LWBS) and elopement rates as more people utilize the ED as their primary care provider. In response to this problem, staff initiated a throughput process model in April 2006. The goal was to (1) reduce elopements and (2) provide more rapid physician assessment following initial nursing triage assessment.

Participants: ED medical and nursing staff .

Subjects: Medium acuity ED patients ("3-2" on 5-level triage scale).

Design: The "Virtual ED" (VED) team includes an ED physician, nurse and clinical assistant. After receiving an initial triage assessment by an RN, medium acuity patients (the greatest volume of patients) are quickly routed to the VED area for a second assessment by a VED physician. Patients move through the VED on their way to diagnostic areas of the ED prior to assignment of ED bed. Lower acuity patients are routed the "Fast Track" to be seen by an APN. Higher acuity patients are moved to the trauma/critical care area.

Methods: Prior to the VED, the rate of elopement had been as high as 9-11%. The national benchmark for elopements is 2-4% with best practice under 2%. Based on a study of LWBS patients, the average acuity was "3" on a 5-point triage scale, so the team implemented a model based on entry and early access to clinical treatment (REACT) program.

Results: From April to November 2006, the ED experienced a drop in LWBS rates from an average 9-11% to 6% -- a 35% decrease in seven months. ED length of visit for inpatients decreased from an average of 447 to 361 minutes and outpatient length of stay decreased from an average 208 to 190 minutes. Using an average of $1,000 average gross revenue per outpatient visit, the additional gross revenue due to the decreased LWBS (about 190 patients per month) is approximately $2.25 million per year. Nurse to patient ratios were maintained per staffing guidelines by the Emergency Nurses Association with a 1:4 ratio.

Recommendations: The concept of the VED has been utilized by other facilities nationally, but is not common practice. Research of this model of throughput management continues to determine long-term cost-effectiveness, length of stay, and LWBS rates. The VED of this hospital is the first of its kind in Central Texas - but it can serve as a model to others.
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.titleSafely Caring for More Patients - Faster - in a Busy EDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162686-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Safely Caring for More Patients - Faster - in a Busy ED</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">Chang, Julia, RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Brackenridge Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Sr. RN Project Coordinator, Staff Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Austin, TX, 78701-, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(512) 324-7000</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jchang@seton.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Daphne Wofford, RN, MSN; Clay Adam, RN, BSN, CEN; Mark Wilson, FNP; Ricky Ritchie, LVN; Shonna Tobias, RN, BSN; Felix McCoy, LVN; Patrick Crocker, DO; Michael Mouw, MD</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Nationally, emergency departments (ED) face overcrowding and increasing Left-Without-Being-Seen (LWBS) and elopement rates as more people utilize the ED as their primary care provider. In response to this problem, staff initiated a throughput process model in April 2006. The goal was to (1) reduce elopements and (2) provide more rapid physician assessment following initial nursing triage assessment.<br/><br/>Participants: ED medical and nursing staff .<br/><br/>Subjects: Medium acuity ED patients (&quot;3-2&quot; on 5-level triage scale).<br/><br/>Design: The &quot;Virtual ED&quot; (VED) team includes an ED physician, nurse and clinical assistant. After receiving an initial triage assessment by an RN, medium acuity patients (the greatest volume of patients) are quickly routed to the VED area for a second assessment by a VED physician. Patients move through the VED on their way to diagnostic areas of the ED prior to assignment of ED bed. Lower acuity patients are routed the &quot;Fast Track&quot; to be seen by an APN. Higher acuity patients are moved to the trauma/critical care area. <br/><br/>Methods: Prior to the VED, the rate of elopement had been as high as 9-11%. The national benchmark for elopements is 2-4% with best practice under 2%. Based on a study of LWBS patients, the average acuity was &quot;3&quot; on a 5-point triage scale, so the team implemented a model based on entry and early access to clinical treatment (REACT) program. <br/><br/>Results: From April to November 2006, the ED experienced a drop in LWBS rates from an average 9-11% to 6% -- a 35% decrease in seven months. ED length of visit for inpatients decreased from an average of 447 to 361 minutes and outpatient length of stay decreased from an average 208 to 190 minutes. Using an average of $1,000 average gross revenue per outpatient visit, the additional gross revenue due to the decreased LWBS (about 190 patients per month) is approximately $2.25 million per year. Nurse to patient ratios were maintained per staffing guidelines by the Emergency Nurses Association with a 1:4 ratio. <br/><br/>Recommendations: The concept of the VED has been utilized by other facilities nationally, but is not common practice. Research of this model of throughput management continues to determine long-term cost-effectiveness, length of stay, and LWBS rates. The VED of this hospital is the first of its kind in Central Texas - but it can serve as a model to others.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:26Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:26Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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