2.50
Hdl Handle:
http://hdl.handle.net/10755/162729
Type:
Presentation
Title:
Alleviating Emergency Department Crowding Through Bed Management
Abstract:
Alleviating Emergency Department Crowding Through Bed Management
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Stamps, Deborah, MS, RN, GNP, CAN, BC
P.I. Institution Name:Rochester General Hospital
Title:Director of Nursing
Contact Address:1425 Portland Avenue, Rochester, NY, 14621, USA
Contact Telephone:(585) 922-4415
Co-Authors:Maryann Valentine, BS, RN
Purpose: It is well known that the increase in emergency department (ED) visits compounded by the steady closing of hospitals nationwide directly contributes to ED crowding. Subsequently, ED crowding leads to the diversion of patients away to other facilities translating into lost revenue as well as decreased satisfaction at all levels (patient, staff, and community). With a daily hospital occupancy rate greater than 94% and diversion hours for 2002-2004 around 1200 per year, the purpose of this project was to decrease the number of ED patients who could be directly admitted to the hospital, thus helping to alleviate ED crowding.

Design: This is a quality improvement project.

Setting: A 528-bed acute care, teaching hospital that is located in New York State.

Participants: The participants consisted of senior leadership, nursing, physicians, environmental services, the direct admission line, care managers, and registration; every department had involvement.

Methods: This improvement focus began in 2003 and continues today. A direct admission line (staffed by registered nurses) is always open and facilitates the direct admission of patients to inpatient units, thereby reducing ED crowding. The existing clinical bed coordination coverage was expanded from forty hours per week to 24 hours per day, seven days per week. Next, the issue of having access to real-time data of bed availability was addressed through the implementation of clinical software programs that enabled the bed coordination staff to view the status of all in-patient beds. Staff is able to enter in expected discharge dates and times into the program which allows the bed coordination staff access to probable discharge dates and times for all patients. An interdisciplinary "surge capacity" meets biweekly to review data and outcomes.

Results: In 2004, more than 2,000 patients were admitted directly avoiding the emergency department; a 15% increase over 2003. In October 2005 and October 2006, 1,621 and 1,872 patients were directly admitted, respectively; an increase of 251 patients. In 2005, 165 patients were admitted through the emergency department versus 185 in 2006. Anecdotally, the feedback has been very positive by physicians who use the direct admission line. Patients who are admitted directly have expressed their overall satisfaction as 87.5%, on average. The number of patients transferred from the emergency department to the medical intensive care unit has increased from 812 to 906 transfers January - October for 2005 and 2006, respectively; 80% of these patients are transferred within 2 - 4 hours. Diversion hours have decreased from 967.5 to 216.4 from January - October for 2005 and 2006, respectively.

Recommendations: The process of improving patient throughput is ongoing and collaborative. As this team continues to address patients' needs through collaboration, planning, data analysis, and communication, the results continue to be positive. Continued development and implementation of new policies to improve patient flow are warranted. The emergency department and clinical bed coordinators working closely together is key to facilitating patient movement.
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.titleAlleviating Emergency Department Crowding Through Bed Managementen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162729-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Alleviating Emergency Department Crowding Through Bed Management</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">Stamps, Deborah, MS, RN, GNP, CAN, BC</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Rochester General Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director of Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1425 Portland Avenue, Rochester, NY, 14621, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(585) 922-4415</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">debbie.stamps@viahealth.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Maryann Valentine, BS, RN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: It is well known that the increase in emergency department (ED) visits compounded by the steady closing of hospitals nationwide directly contributes to ED crowding. Subsequently, ED crowding leads to the diversion of patients away to other facilities translating into lost revenue as well as decreased satisfaction at all levels (patient, staff, and community). With a daily hospital occupancy rate greater than 94% and diversion hours for 2002-2004 around 1200 per year, the purpose of this project was to decrease the number of ED patients who could be directly admitted to the hospital, thus helping to alleviate ED crowding.<br/><br/>Design: This is a quality improvement project.<br/><br/>Setting: A 528-bed acute care, teaching hospital that is located in New York State.<br/><br/>Participants: The participants consisted of senior leadership, nursing, physicians, environmental services, the direct admission line, care managers, and registration; every department had involvement.<br/><br/>Methods: This improvement focus began in 2003 and continues today. A direct admission line (staffed by registered nurses) is always open and facilitates the direct admission of patients to inpatient units, thereby reducing ED crowding. The existing clinical bed coordination coverage was expanded from forty hours per week to 24 hours per day, seven days per week. Next, the issue of having access to real-time data of bed availability was addressed through the implementation of clinical software programs that enabled the bed coordination staff to view the status of all in-patient beds. Staff is able to enter in expected discharge dates and times into the program which allows the bed coordination staff access to probable discharge dates and times for all patients. An interdisciplinary &quot;surge capacity&quot; meets biweekly to review data and outcomes.<br/><br/>Results: In 2004, more than 2,000 patients were admitted directly avoiding the emergency department; a 15% increase over 2003. In October 2005 and October 2006, 1,621 and 1,872 patients were directly admitted, respectively; an increase of 251 patients. In 2005, 165 patients were admitted through the emergency department versus 185 in 2006. Anecdotally, the feedback has been very positive by physicians who use the direct admission line. Patients who are admitted directly have expressed their overall satisfaction as 87.5%, on average. The number of patients transferred from the emergency department to the medical intensive care unit has increased from 812 to 906 transfers January - October for 2005 and 2006, respectively; 80% of these patients are transferred within 2 - 4 hours. Diversion hours have decreased from 967.5 to 216.4 from January - October for 2005 and 2006, respectively. <br/><br/>Recommendations: The process of improving patient throughput is ongoing and collaborative. As this team continues to address patients' needs through collaboration, planning, data analysis, and communication, the results continue to be positive. Continued development and implementation of new policies to improve patient flow are warranted. The emergency department and clinical bed coordinators working closely together is key to facilitating patient movement.</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:10Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:10Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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