Going into "Overdrive:" A Program to Manage Patient Throughput in the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/162725
Type:
Presentation
Title:
Going into "Overdrive:" A Program to Manage Patient Throughput in the Emergency Department
Abstract:
Going into "Overdrive:" A Program to Manage Patient Throughput in the Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Finefrock, Susan, RN, MS
P.I. Institution Name:Riverside Methodist Hospital
Title:Assistant Nurse Manager, Emergency Department
Contact Address:3535 Olentangy River Road, Columbus, OH, 43221, USA
Contact Telephone:(614) 566-5070
Purpose: As more and more people turn to emergency departments (EDs) for non-emergency care, ED crowding has become a nationwide problem, a trend experts say is likely to grow. With increased patient volume, ED beds fill quickly, packing waiting rooms with incoming and already triaged patients, causing longer lengths of stay and increased rates of diversion. To address these issues, we evaluated our throughput system and developed a plan to be activated before patient volume exceeds patient capacity, thereby averting a crowded emergency department and its attendant consequences.

Design: A collaborative, management-driven improvement project designed by ED nurses, technicians, and physicians that relies on multidisciplinary personnel.

Setting: A 750-bed tertiary Magnet Hospital and teaching facility located in the suburbs, with a Level II Trauma Center, certification as a Stroke Center & Chest Pain Center, and annual patient visits for 2006 of 86,000.

Subjects: All patients presenting to the emergency department and all personnel as specified above.

Methods: In the "Overflow" phase, incoming ED patients meeting ESI-3 criteria are overflowed into assigned beds in basic care and/or continuing care, when 80% of the main treatment area ED beds are full; in phase 2, intake personnel initiate diagnostic "protocols" previously developed by ED physicians and nurses to expedite lab and radiology studies; in phase 3 (still a work in progress), the ED physician further expedites care by initiating additional orders in the intake area or discharging patients meeting ESI 3 & 4 criteria; in the final phase, the emergency department has reached bed and staff capacity and patients are diverted to other hospitals (excluding unstable and trauma patients). "Census Alert" can be activated any time during Overdrive when any one or more of the following situations emerge: more than 80 patients are waiting, more than 15 admitted patients have waited over 60 minutes without bed assignment, when multiple critical patients require 1:1 nursing care, or when multiple triaged patients continue to wait in the ED lobby for an assigned bed. In these instances, the nurse administrator and relevant departments are alerted, with the expectation that admitted patients will be prioritized, beds assigned, and inpatients moved out of the emergency department.

Results: Since implementing the program in 2006, our diversion rate has dropped from more than 240 hours of ED closure per calendar year in 2004, to 20 hours in 2005, and our ED length of stay has held constant over the same time period, despite a 14% rise in our census for. The additional phase, "Census Alert" phase has hastened patient throughput by moving admitted patients to inpatient beds more quickly.

Recommendations: Waiting until the emergency department is in crisis to address patient throughput makes it more difficult to solve the problem of ED crowding. Emergency departments must already have a proactive, structured plan in place that will move patients quickly through the emergency department, thereby preempting a critical situation that results in diversion.
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.titleGoing into "Overdrive:" A Program to Manage Patient Throughput in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162725-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Going into &quot;Overdrive:&quot; A Program to Manage Patient Throughput in the Emergency Department</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">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Finefrock, Susan, RN, MS</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Riverside Methodist Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Nurse Manager, Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3535 Olentangy River Road, Columbus, OH, 43221, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(614) 566-5070</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">scfinefrock@yahoo.com</td></tr><tr><td colspan="2" class="item-abstract">Purpose: As more and more people turn to emergency departments (EDs) for non-emergency care, ED crowding has become a nationwide problem, a trend experts say is likely to grow. With increased patient volume, ED beds fill quickly, packing waiting rooms with incoming and already triaged patients, causing longer lengths of stay and increased rates of diversion. To address these issues, we evaluated our throughput system and developed a plan to be activated before patient volume exceeds patient capacity, thereby averting a crowded emergency department and its attendant consequences.<br/><br/>Design: A collaborative, management-driven improvement project designed by ED nurses, technicians, and physicians that relies on multidisciplinary personnel.<br/><br/>Setting: A 750-bed tertiary Magnet Hospital and teaching facility located in the suburbs, with a Level II Trauma Center, certification as a Stroke Center &amp; Chest Pain Center, and annual patient visits for 2006 of 86,000.<br/><br/>Subjects: All patients presenting to the emergency department and all personnel as specified above.<br/><br/>Methods: In the &quot;Overflow&quot; phase, incoming ED patients meeting ESI-3 criteria are overflowed into assigned beds in basic care and/or continuing care, when 80% of the main treatment area ED beds are full; in phase 2, intake personnel initiate diagnostic &quot;protocols&quot; previously developed by ED physicians and nurses to expedite lab and radiology studies; in phase 3 (still a work in progress), the ED physician further expedites care by initiating additional orders in the intake area or discharging patients meeting ESI 3 &amp; 4 criteria; in the final phase, the emergency department has reached bed and staff capacity and patients are diverted to other hospitals (excluding unstable and trauma patients). &quot;Census Alert&quot; can be activated any time during Overdrive when any one or more of the following situations emerge: more than 80 patients are waiting, more than 15 admitted patients have waited over 60 minutes without bed assignment, when multiple critical patients require 1:1 nursing care, or when multiple triaged patients continue to wait in the ED lobby for an assigned bed. In these instances, the nurse administrator and relevant departments are alerted, with the expectation that admitted patients will be prioritized, beds assigned, and inpatients moved out of the emergency department.<br/><br/>Results: Since implementing the program in 2006, our diversion rate has dropped from more than 240 hours of ED closure per calendar year in 2004, to 20 hours in 2005, and our ED length of stay has held constant over the same time period, despite a 14% rise in our census for. The additional phase, &quot;Census Alert&quot; phase has hastened patient throughput by moving admitted patients to inpatient beds more quickly.<br/><br/>Recommendations: Waiting until the emergency department is in crisis to address patient throughput makes it more difficult to solve the problem of ED crowding. Emergency departments must already have a proactive, structured plan in place that will move patients quickly through the emergency department, thereby preempting a critical situation that results in diversion.</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:06Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:06Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.