Emergency Department Crowding: Creating a Platform for Change Through Definition, Measurement, and Reporting

2.50
Hdl Handle:
http://hdl.handle.net/10755/162730
Type:
Presentation
Title:
Emergency Department Crowding: Creating a Platform for Change Through Definition, Measurement, and Reporting
Abstract:
Emergency Department Crowding: Creating a Platform for Change Through Definition, Measurement, and Reporting
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Stone-Griffith, Suzanne, RN, MSN, CNAA
P.I. Institution Name:HCA
Title:AVP Quality
Contact Address:One Park Plaza Building II 4 West, Nashville, TN, 37203, USA
Contact Telephone:(615) 344-5580
Co-Authors:Diane Freeman RN, PHN, MSN and Camille Compton, RN
Purpose: Crowding of emergency departments is the number one issue of concern for the future of emergency care. Holding of inpatients is the key contributing factor to the crowding condition many emergency departments face. If this condition is not defined, measured, and reported in a form and format that key hospital executives understand, effective strategies to combat the problem will not be developed. The purpose of this project was to determine if the process of obtaining aggregated, consistent data related to ED holding could be automated, defined, measured, and reported.

Design: This project was a pilot study for quality improvement.

Setting: This project consisted of eleven hospitals (within this corporation) nationwide, ranging in size and complexity of services. The hospitals were selected by each division president and management engineer.

Participants: A project team that included emergency department directors, chief nursing executives, chief financial officers, management engineers, patient access directors, and hospital information directors was integral to the project's success.

Methods: The project began in May 2006 and concluded in August 2006. An non-procedure representation (NPR) report was created in the clinical information system, MEDITECH, that would allow the capture of holding hours by type of holding hours, i.e., intensive care, telemetry/step down, pediatrics, pediatric intensive care, medical, and surgical patients. A new quantitative management information reporting system (QMIRS) statistic was created in the financial systems to allow each controller to report the data monthly at financial close. A definition and process to capture the data was developed and agreed upon. Reporting of holding hours began in July.

Results: All eleven hospitals were all able to automate the capture of emergency department holding hours and report those along with their emergency department visits as a new financial statistic. They were also able to use the report and the hours of care by patient type to explain variation in their productivity related to the care of these patients. This process allowed for the monitoring of the number of holding hours and aggregates them by market, division, and geographic region. It also allowed for the measurement of the quantity and complexity of ED holding patients and the impact these have on patient flow and throughput.

Recommendations: Given the success of the project, we are now in the process of converting all 178 emergency departments to the new process and method of reporting this statistic across the company. The newly created reports will become part of our main menu of reports. In addition this report will become part of the financial analysis for labor performance in the emergency department. What you define and measure in a consistent fashion will allow for targeted and meaningful improvements. Holding and boarding of inpatients in the emergency department is the key driver of efficient patient flow. To complicate matters, holding and boarding of inpatients is not typically within the control of the emergency department. Therefore meaningful data is critically important to making overall organizational changes.
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.titleEmergency Department Crowding: Creating a Platform for Change Through Definition, Measurement, and Reportingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162730-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Emergency Department Crowding: Creating a Platform for Change Through Definition, Measurement, and Reporting</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">Stone-Griffith, Suzanne, RN, MSN, CNAA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">HCA</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">AVP Quality</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">One Park Plaza Building II 4 West, Nashville, TN, 37203, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(615) 344-5580</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Suzanne.stone-griffith@hcahealthcare.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Diane Freeman RN, PHN, MSN and Camille Compton, RN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Crowding of emergency departments is the number one issue of concern for the future of emergency care. Holding of inpatients is the key contributing factor to the crowding condition many emergency departments face. If this condition is not defined, measured, and reported in a form and format that key hospital executives understand, effective strategies to combat the problem will not be developed. The purpose of this project was to determine if the process of obtaining aggregated, consistent data related to ED holding could be automated, defined, measured, and reported.<br/><br/>Design: This project was a pilot study for quality improvement.<br/><br/>Setting: This project consisted of eleven hospitals (within this corporation) nationwide, ranging in size and complexity of services. The hospitals were selected by each division president and management engineer. <br/><br/>Participants: A project team that included emergency department directors, chief nursing executives, chief financial officers, management engineers, patient access directors, and hospital information directors was integral to the project's success. <br/><br/>Methods: The project began in May 2006 and concluded in August 2006. An non-procedure representation (NPR) report was created in the clinical information system, MEDITECH, that would allow the capture of holding hours by type of holding hours, i.e., intensive care, telemetry/step down, pediatrics, pediatric intensive care, medical, and surgical patients. A new quantitative management information reporting system (QMIRS) statistic was created in the financial systems to allow each controller to report the data monthly at financial close. A definition and process to capture the data was developed and agreed upon. Reporting of holding hours began in July. <br/><br/>Results: All eleven hospitals were all able to automate the capture of emergency department holding hours and report those along with their emergency department visits as a new financial statistic. They were also able to use the report and the hours of care by patient type to explain variation in their productivity related to the care of these patients. This process allowed for the monitoring of the number of holding hours and aggregates them by market, division, and geographic region. It also allowed for the measurement of the quantity and complexity of ED holding patients and the impact these have on patient flow and throughput. <br/><br/>Recommendations: Given the success of the project, we are now in the process of converting all 178 emergency departments to the new process and method of reporting this statistic across the company. The newly created reports will become part of our main menu of reports. In addition this report will become part of the financial analysis for labor performance in the emergency department. What you define and measure in a consistent fashion will allow for targeted and meaningful improvements. Holding and boarding of inpatients in the emergency department is the key driver of efficient patient flow. To complicate matters, holding and boarding of inpatients is not typically within the control of the emergency department. Therefore meaningful data is critically important to making overall organizational changes.</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:11Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:11Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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