Expediting Emergency Department Patient Care, Improving ED and Hospital Operations

2.50
Hdl Handle:
http://hdl.handle.net/10755/162912
Type:
Presentation
Title:
Expediting Emergency Department Patient Care, Improving ED and Hospital Operations
Abstract:
Expediting Emergency Department Patient Care, Improving ED and Hospital Operations
Conference Sponsor:Emergency Nurses Association
Conference Year:2006
Author:LaMonica, Patti, RN, MSN
P.I. Institution Name:MidState Medical Center
Title:Director Emergency Services
Contact Address:435 Lewis Ave., Meriden, CT, 06451, USA
Contact Telephone:(203) 694-8356
Co-Authors:Patti LaMonica, RN, MSN; Patty Pomposi, RN
Purpose: A limited number of inpatient beds and an emergency department (ED) that long ago had outgrown its intended capacity led to high volumes of admitted-ED holds and severe ED overcrowding at this acute care hospital in Central Connecticut. JCAHO cites admitted holds as a national problem that can reduce patient safety and quality of care. At our ED, this problem manifested itself in delays in care and decreased patient and staff satisfaction. Our commitment to ourselves, as a team, and to our patients, as caregivers, demanded that we respond. We knew the bottlenecks were not ours alone, but occurred throughout the hospital, thus only a hospital-wide approach could reverse them. In November 2004, an executive-sponsored, multidisciplinary team was created to identify and address causes of admitted holds, with the goal of improving patient flow and care throughout the ED and hospital at large. Implementation: The Patient Throughput Actiongroup (PTA), made up of ED nurses, physicians, administrators and other personnel, studied patient flow from the waiting room (or ambulance bay) to the ED, from the ED to the inpatient setting, and from the inpatient setting to discharge. Using flow charts of current ED and hospital operations, a rolling "idea list" was created to identify barriers to ED care. A cost-benefit analysis approach determined the initiatives we would pursue. These included the establishment of a hospital-wide "capacity code" policy that alerts other hospital staff to prepare non-ED spaces for pre-admitted care; instituting ED bedside registration; establishing a "Rapid Assessment Team" for newly arrived ED patients; streamlining the admissions process via use of physician order entry, cell phones and beepers; installing software to track inpatient room preparation; establishing an ED-dedicated patient transporter; and increasing AM discharges to free up inpatient beds. Staff continues to monitor these initiatives by filling out worksheets in real time on door-to-ED-bed time, door-to-doc time, and ED arrival-to-inpatient bed time. Outcomes: Since implementing our Capacity Code policy, preadmission care of patients held in the ED has improved, along with staff and patient satisfaction. Significant fluctuation in the number of ED-admitted patients and the absence of long-term data prevents us from knowing whether our admit-hold burden has improved, although our impression is that it has. Of the outcomes we have been able to measure, for the period of November 20004 to May 2005, we found patient triage-to-ED bed time decreased by 50-60%; the number of steps from decision-to-admit to inpatient bed assignment declined from 5 to 2 steps; inpatient bed turnaround time decreased by 8%; ED door-to-doc time decreased by 22 minutes; and door-to inpatient-room-ready time declined by 60%. Recommendations: Barriers to ED patient flow can often be traced to other departments, and their removal demands nothing less than a hospital-wide commitment, including significant support from administrators . The effort is worth it. Since implementing our program in 2004, we have effected many positive changes in ED patient throughput and quality of patient care. ED staff morale has been restored; knowing other departments are aware of capacity problems and are pitching in has taken the edge off of staff frustrations. This outcome is particularly gratifying for ED nurses, who led the charge, engaged other personnel, and are now beginning to see the results of their labors. [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.titleExpediting Emergency Department Patient Care, Improving ED and Hospital Operationsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162912-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Expediting Emergency Department Patient Care, Improving ED and Hospital Operations</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">Director 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">Patti LaMonica, RN, MSN; Patty Pomposi, RN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: A limited number of inpatient beds and an emergency department (ED) that long ago had outgrown its intended capacity led to high volumes of admitted-ED holds and severe ED overcrowding at this acute care hospital in Central Connecticut. JCAHO cites admitted holds as a national problem that can reduce patient safety and quality of care. At our ED, this problem manifested itself in delays in care and decreased patient and staff satisfaction. Our commitment to ourselves, as a team, and to our patients, as caregivers, demanded that we respond. We knew the bottlenecks were not ours alone, but occurred throughout the hospital, thus only a hospital-wide approach could reverse them. In November 2004, an executive-sponsored, multidisciplinary team was created to identify and address causes of admitted holds, with the goal of improving patient flow and care throughout the ED and hospital at large. Implementation: The Patient Throughput Actiongroup (PTA), made up of ED nurses, physicians, administrators and other personnel, studied patient flow from the waiting room (or ambulance bay) to the ED, from the ED to the inpatient setting, and from the inpatient setting to discharge. Using flow charts of current ED and hospital operations, a rolling &quot;idea list&quot; was created to identify barriers to ED care. A cost-benefit analysis approach determined the initiatives we would pursue. These included the establishment of a hospital-wide &quot;capacity code&quot; policy that alerts other hospital staff to prepare non-ED spaces for pre-admitted care; instituting ED bedside registration; establishing a &quot;Rapid Assessment Team&quot; for newly arrived ED patients; streamlining the admissions process via use of physician order entry, cell phones and beepers; installing software to track inpatient room preparation; establishing an ED-dedicated patient transporter; and increasing AM discharges to free up inpatient beds. Staff continues to monitor these initiatives by filling out worksheets in real time on door-to-ED-bed time, door-to-doc time, and ED arrival-to-inpatient bed time. Outcomes: Since implementing our Capacity Code policy, preadmission care of patients held in the ED has improved, along with staff and patient satisfaction. Significant fluctuation in the number of ED-admitted patients and the absence of long-term data prevents us from knowing whether our admit-hold burden has improved, although our impression is that it has. Of the outcomes we have been able to measure, for the period of November 20004 to May 2005, we found patient triage-to-ED bed time decreased by 50-60%; the number of steps from decision-to-admit to inpatient bed assignment declined from 5 to 2 steps; inpatient bed turnaround time decreased by 8%; ED door-to-doc time decreased by 22 minutes; and door-to inpatient-room-ready time declined by 60%. Recommendations: Barriers to ED patient flow can often be traced to other departments, and their removal demands nothing less than a hospital-wide commitment, including significant support from administrators . The effort is worth it. Since implementing our program in 2004, we have effected many positive changes in ED patient throughput and quality of patient care. ED staff morale has been restored; knowing other departments are aware of capacity problems and are pitching in has taken the edge off of staff frustrations. This outcome is particularly gratifying for ED nurses, who led the charge, engaged other personnel, and are now beginning to see the results of their labors. [Clinical Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:36:18Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:36:18Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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