2.50
Hdl Handle:
http://hdl.handle.net/10755/162911
Type:
Presentation
Title:
Using a "Rapid Assessment Team" to Decrease ED Waiting Time
Abstract:
Using a "Rapid Assessment Team" to Decrease ED Waiting Time
Conference Sponsor:Emergency Nurses Association
Conference Year:2006
Author:LaMonica, Patti, RN, MSN
P.I. Institution Name:MidState Medical Center
Title:Manager, Emergency Services
Contact Address:435 Lewis Ave., Meriden, CT, 06451, USA
Contact Telephone:(203) 694-8356
Co-Authors:Fred Tilden, MD; Laurie Lohman, MD; Patti LaMonica, RN, MSN
Purpose: Patient satisfaction in the Emergency Department (ED) depends primarily on how quickly patients are seen by the ED physician (door-to-doc time). At our ED, annual patient volumes of 50,000 far exceeded our physical capacity of 28,000, causing severe overcrowding and door to doc time delays. As a result, patient satisfaction and staff morale declined. The goal of this project was to find ways to adjust our operations that would decrease door-to-doc time and increase patient and staff satisfaction. Implementation: In 2004, ED administrators and other ED staff held multiple meetings with hospital-wide personnel to study problems in ED throughput and identify how operations could be changed to expedite door-to-doc times. The result was the creation of the Rapid Assessment (RA) Team. The team consists of a dedicated RA nurse, physician and nursing technician, whose job is to provide quick, preliminary diagnostic workup and therapy to incoming patients, leaving definitive care and patient disposition to the primary nurse/physician team. Two trials of the program took place with registration taken at bedside. In the first, waiting room patients were seen in a dedicated RA area then transferred to their ED bed. In the second trial, the RA Team saw both waiting room and ambulance patients at bedside. Differences in physician practice styles were noted on worksheet completed by physicians. RA nurses and physicians also collected data to measure time intervals and to assess operational issues in real time. Variables included registration time, RA team care interval, primary team care interval, patient diagnoses, and whether patients were definitively cared for by the RA team. Staff perception of patient care, job satisfaction and job stress were also measured in a survey conducted shortly after implementing the RA program and two months later. Outcomes: Our door-to physician time decreased markedly when the RA Team was working. Door-to-doc time before implementing the program was 52 minutes compared to 23 minutes for the first trail, and 20.3 minutes for the second trial. Staff preferred the second trial over the first, as it did not require a patient location change. Observationally, the waiting room seemed much less crowded when the RA Team worked, and higher patient satisfaction scores reflected this. Staff satisfaction also improved, although initially this was variable. It took some time for staff to adapt to the significant operational change. RA physicians had to get used to handing off definitive care, and both RA nurses and physicians had to learn how to communicate with charge and primary nurses. What's more, individual physicians and nurses differed in their ability and inclination to rapidly assess and treat patients before moving on to the next one. These qualities are crucial to the successful function of the RA Team: if the team holds on to patients too long, they defeat the purpose of the program. These individual variations are therefore now being studied. Recommendations: A Rapid Assessment Team approach can result in more timely patient care and greater staff and patient satisfaction. However, hospitals that implement this approach must be aware that clinical practice styles and skills among nurses and physicians vary and may affect how individuals function in a Rapid Assessment Team. Some nurses more than others may find it easy to delegate and deliver quick care to patients before moving on, while some physicians may be better than others at making rapid decisions and transferring subsequent judgments to primary physicians. Nonetheless, once the RA team and other ED staff adapt to the demands of rapid assessment and care, greater patient and staff satisfaction should follow. [Clinical Presentation]
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.titleUsing a "Rapid Assessment Team" to Decrease ED Waiting Timeen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162911-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Using a &quot;Rapid Assessment Team&quot; to Decrease ED Waiting Time</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">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">LaMonica, Patti, RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">MidState Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Manager, Emergency Services</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">435 Lewis Ave., Meriden, CT, 06451, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(203) 694-8356</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">plamoni@midstatemedical.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Fred Tilden, MD; Laurie Lohman, MD; Patti LaMonica, RN, MSN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Patient satisfaction in the Emergency Department (ED) depends primarily on how quickly patients are seen by the ED physician (door-to-doc time). At our ED, annual patient volumes of 50,000 far exceeded our physical capacity of 28,000, causing severe overcrowding and door to doc time delays. As a result, patient satisfaction and staff morale declined. The goal of this project was to find ways to adjust our operations that would decrease door-to-doc time and increase patient and staff satisfaction. Implementation: In 2004, ED administrators and other ED staff held multiple meetings with hospital-wide personnel to study problems in ED throughput and identify how operations could be changed to expedite door-to-doc times. The result was the creation of the Rapid Assessment (RA) Team. The team consists of a dedicated RA nurse, physician and nursing technician, whose job is to provide quick, preliminary diagnostic workup and therapy to incoming patients, leaving definitive care and patient disposition to the primary nurse/physician team. Two trials of the program took place with registration taken at bedside. In the first, waiting room patients were seen in a dedicated RA area then transferred to their ED bed. In the second trial, the RA Team saw both waiting room and ambulance patients at bedside. Differences in physician practice styles were noted on worksheet completed by physicians. RA nurses and physicians also collected data to measure time intervals and to assess operational issues in real time. Variables included registration time, RA team care interval, primary team care interval, patient diagnoses, and whether patients were definitively cared for by the RA team. Staff perception of patient care, job satisfaction and job stress were also measured in a survey conducted shortly after implementing the RA program and two months later. Outcomes: Our door-to physician time decreased markedly when the RA Team was working. Door-to-doc time before implementing the program was 52 minutes compared to 23 minutes for the first trail, and 20.3 minutes for the second trial. Staff preferred the second trial over the first, as it did not require a patient location change. Observationally, the waiting room seemed much less crowded when the RA Team worked, and higher patient satisfaction scores reflected this. Staff satisfaction also improved, although initially this was variable. It took some time for staff to adapt to the significant operational change. RA physicians had to get used to handing off definitive care, and both RA nurses and physicians had to learn how to communicate with charge and primary nurses. What's more, individual physicians and nurses differed in their ability and inclination to rapidly assess and treat patients before moving on to the next one. These qualities are crucial to the successful function of the RA Team: if the team holds on to patients too long, they defeat the purpose of the program. These individual variations are therefore now being studied. Recommendations: A Rapid Assessment Team approach can result in more timely patient care and greater staff and patient satisfaction. However, hospitals that implement this approach must be aware that clinical practice styles and skills among nurses and physicians vary and may affect how individuals function in a Rapid Assessment Team. Some nurses more than others may find it easy to delegate and deliver quick care to patients before moving on, while some physicians may be better than others at making rapid decisions and transferring subsequent judgments to primary physicians. Nonetheless, once the RA team and other ED staff adapt to the demands of rapid assessment and care, greater patient and staff satisfaction should follow. [Clinical Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:36:16Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:36:16Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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