2.50
Hdl Handle:
http://hdl.handle.net/10755/162726
Type:
Presentation
Title:
Changing the Facts of Life in the ED
Abstract:
Changing the Facts of Life in the ED
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Fisher, Linda, RN, MSN
P.I. Institution Name:Boston Medical Center
Title:Director of Emergency Nursing
Contact Address:One Boston Medical Center Place, Boston, MA, 02118, USA
Contact Telephone:(617) 414-5351
Purpose: A significant number of emergency department (ED) patients present to the emergency department for services that can be best served in other settings. This impacts crowding, ED diversion, patient flow, bed availability, staffing, and costs. The purpose of this project was to decrease the number of emergency department services accessed by select patients who have a history of recidivism.

Design: This was a multidisciplinary performance improvement initiative consisting of committee comprised of a nurse, physician, social worker, and administrator.

Setting: Large urban academic level 1 trauma center with an annual census of 128,000 ED visits.

Subjects: A list of all patients who frequent the emergency department was generated through the electronic ED tracking system and the top ten most frequent ED users were followed over a nine-month period.

Methods: Following a model successfully used at a Vancouver hospital, a multi-disciplinary group of care-givers and administrators identified the needs of frequent ED users. The needs assessment included the existence of families, primary care providers, their state of residency, and their living patterns. Members of this multi-disciplinary group included a nurse, physician, administrator, and social worker. Based on the individual needs, the team developed care plans for each individual with interventions that ranged from providing food and or determining shelter to confining them to a locked facility. In addition, the team addressed patient-provider relationships and family support systems. The care plan was linked to patient's medical records to ensure consistency and adherence to the care plan by medical staff.

Results: This performance improvement project showed a 67% decrease in total length of stay in the ED for the ten patients over a 9-month period. The time spent in the ED decreased from approximately 12,000 minutes to 4,000 minutes. Of the ten subjects, nine (90%) presented with alcohol-related issues. The tenth subject presented with multiple social issues.

Recommendations: This program has the potential to positively impact patient flow, decrease unnecessary ED visits and unnecessary use of emergency services, and improve quality of care. Nurses are crucial members of the multidisciplinary improvement process. Emergency departments could benefit from a full time social worker to assist with such complex, challenging patients. Many more ED patients meet the criteria of frequent visits to the emergency department and could benefit from such specialized care plans and the increase level of support. The common problem of recidivism places a tremendous financial burden on organizations when emergency services are inappropriately utilized.
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.titleChanging the Facts of Life in the EDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162726-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Changing the Facts of Life in the 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">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Fisher, Linda, RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Boston Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director of Emergency Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">One Boston Medical Center Place, Boston, MA, 02118, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(617) 414-5351</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Linda.Fisher@Bmc.org</td></tr><tr><td colspan="2" class="item-abstract">Purpose: A significant number of emergency department (ED) patients present to the emergency department for services that can be best served in other settings. This impacts crowding, ED diversion, patient flow, bed availability, staffing, and costs. The purpose of this project was to decrease the number of emergency department services accessed by select patients who have a history of recidivism. <br/><br/>Design: This was a multidisciplinary performance improvement initiative consisting of committee comprised of a nurse, physician, social worker, and administrator. <br/><br/>Setting: Large urban academic level 1 trauma center with an annual census of 128,000 ED visits.<br/><br/>Subjects: A list of all patients who frequent the emergency department was generated through the electronic ED tracking system and the top ten most frequent ED users were followed over a nine-month period.<br/><br/>Methods: Following a model successfully used at a Vancouver hospital, a multi-disciplinary group of care-givers and administrators identified the needs of frequent ED users. The needs assessment included the existence of families, primary care providers, their state of residency, and their living patterns. Members of this multi-disciplinary group included a nurse, physician, administrator, and social worker. Based on the individual needs, the team developed care plans for each individual with interventions that ranged from providing food and or determining shelter to confining them to a locked facility. In addition, the team addressed patient-provider relationships and family support systems. The care plan was linked to patient's medical records to ensure consistency and adherence to the care plan by medical staff.<br/><br/>Results: This performance improvement project showed a 67% decrease in total length of stay in the ED for the ten patients over a 9-month period. The time spent in the ED decreased from approximately 12,000 minutes to 4,000 minutes. Of the ten subjects, nine (90%) presented with alcohol-related issues. The tenth subject presented with multiple social issues.<br/><br/>Recommendations: This program has the potential to positively impact patient flow, decrease unnecessary ED visits and unnecessary use of emergency services, and improve quality of care. Nurses are crucial members of the multidisciplinary improvement process. Emergency departments could benefit from a full time social worker to assist with such complex, challenging patients. Many more ED patients meet the criteria of frequent visits to the emergency department and could benefit from such specialized care plans and the increase level of support. The common problem of recidivism places a tremendous financial burden on organizations when emergency services are inappropriately utilized.</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:07Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:07Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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