2.50
Hdl Handle:
http://hdl.handle.net/10755/162731
Type:
Presentation
Title:
Collaborative Initiatives Can Improve Patient Throughput
Abstract:
Collaborative Initiatives Can Improve Patient Throughput
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Vance, Kim, RN, BSN
P.I. Institution Name:The University Hospital
Title:Director, Center for Emergency Care
Contact Address:234 Goodman Street, Cincinnati, OH, 45219, USA
Contact Telephone:(513) 584-4259
Co-Authors:Katie Shrader RN, BSN; Michelle Nichols RN, BSN; Barb Stammen, RN; and Denise Jackson RN
Purpose: It was noted that a high percentage of emergency department (ED) patients were classified as left without treatment (LWOT) due to excessive waiting times in the emergency department. Three performance improvement (PI) initiatives targeted throughput. The purpose of this project was to decrease ED length of stay (LOS) which would thereby decrease ED waiting times and led to a reduced number of LWOT patients.

Design: This was a performance improvement (PI) project that encompassed three initiatives.

Setting: This is an academic, urban, Level I Trauma Center located in the Midwest.

Participants: A six sigma blackbelt, as well as nurses and physicians from both the emergency department and internal medicine were involved.

Methods: In October 2005, a medical admission express unit (MAEU) was established. Patients placed into MAEU undergo expedited admission assessment, physician and nursing interventions, and patient education prior to in-patient bed assignment. In March 2006, nursing treatment guidelines were implemented to standardize diagnostic testing for the most frequent complaints which enabled nurses to initiate diagnostics prior to physician evaluation. Flow diagrams promoted consistent risk assessment and rapid interventions. In-service sessions were provided for staff training. The guidelines are available on facility computers and the facility web site, and a condensed version is available on laminated cards strategically placed throughout the emergency department. Cardiac multi-marker point-of-care testing, the final initiative, was implemented in August 2005 in order to decrease lab turn-around-time. Patient care associates performed testing and delivered results to the care provider, accelerating disposition decision.

Results: The period of September 2004- August 2005 was compared to that of September 2005- August 2006.A decrease was observed in the following: LWOT was reduced by 25%, diversion hours by 88%, inpatient hold hours by 32%, and emergency department LOS for this in-patient population by 16%. Overall patient satisfaction increased by 2%. From January - October 2005, the average vacancy rate decreased from 29% to 14%. As of November 2006, the current rate is 8%. Standardization of practice through the implementation of guidelines improved direct patient throughput. This increase in nurse autonomy also contributed to a reduction in the nurse turnover rate.

Recommendations: The three PI initiatives have all directly and positively impacted the emergency department. To achieve patient throughput improvements in the emergency department it is necessary to involve all disciplines in the identification and implementation of departmental goals. Successful implementation of performance improvement initiatives requires strong leadership team skills including; communication, coaching, mentoring and modeling. Communicating with and involving the direct care providers in the PI process allows essential first hand knowledge and understanding of patient care issues to be identified and addressed. Using this collaborative approach, these PI initiatives were accomplished. Promoting and supporting direct patient care provider involvement in the departmental operations is key.
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.titleCollaborative Initiatives Can Improve Patient Throughputen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162731-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Collaborative Initiatives Can Improve Patient Throughput</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">Vance, Kim, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The University Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director, Center for Emergency Care</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">234 Goodman Street, Cincinnati, OH, 45219, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(513) 584-4259</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">vanceka@healthall.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Katie Shrader RN, BSN; Michelle Nichols RN, BSN; Barb Stammen, RN; and Denise Jackson RN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: It was noted that a high percentage of emergency department (ED) patients were classified as left without treatment (LWOT) due to excessive waiting times in the emergency department. Three performance improvement (PI) initiatives targeted throughput. The purpose of this project was to decrease ED length of stay (LOS) which would thereby decrease ED waiting times and led to a reduced number of LWOT patients. <br/><br/>Design: This was a performance improvement (PI) project that encompassed three initiatives.<br/><br/>Setting: This is an academic, urban, Level I Trauma Center located in the Midwest.<br/><br/>Participants: A six sigma blackbelt, as well as nurses and physicians from both the emergency department and internal medicine were involved. <br/><br/>Methods: In October 2005, a medical admission express unit (MAEU) was established. Patients placed into MAEU undergo expedited admission assessment, physician and nursing interventions, and patient education prior to in-patient bed assignment. In March 2006, nursing treatment guidelines were implemented to standardize diagnostic testing for the most frequent complaints which enabled nurses to initiate diagnostics prior to physician evaluation. Flow diagrams promoted consistent risk assessment and rapid interventions. In-service sessions were provided for staff training. The guidelines are available on facility computers and the facility web site, and a condensed version is available on laminated cards strategically placed throughout the emergency department. Cardiac multi-marker point-of-care testing, the final initiative, was implemented in August 2005 in order to decrease lab turn-around-time. Patient care associates performed testing and delivered results to the care provider, accelerating disposition decision. <br/><br/>Results: The period of September 2004- August 2005 was compared to that of September 2005- August 2006.A decrease was observed in the following: LWOT was reduced by 25%, diversion hours by 88%, inpatient hold hours by 32%, and emergency department LOS for this in-patient population by 16%. Overall patient satisfaction increased by 2%. From January - October 2005, the average vacancy rate decreased from 29% to 14%. As of November 2006, the current rate is 8%. Standardization of practice through the implementation of guidelines improved direct patient throughput. This increase in nurse autonomy also contributed to a reduction in the nurse turnover rate.<br/><br/>Recommendations: The three PI initiatives have all directly and positively impacted the emergency department. To achieve patient throughput improvements in the emergency department it is necessary to involve all disciplines in the identification and implementation of departmental goals. Successful implementation of performance improvement initiatives requires strong leadership team skills including; communication, coaching, mentoring and modeling. Communicating with and involving the direct care providers in the PI process allows essential first hand knowledge and understanding of patient care issues to be identified and addressed. Using this collaborative approach, these PI initiatives were accomplished. Promoting and supporting direct patient care provider involvement in the departmental operations is key.</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:12Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:12Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.