2.50
Hdl Handle:
http://hdl.handle.net/10755/162921
Type:
Presentation
Title:
Removing Barriers to Patient Flow: A Systems Analysis Approach
Abstract:
Removing Barriers to Patient Flow: A Systems Analysis Approach
Conference Sponsor:Emergency Nurses Association
Conference Year:2006
Author:Smith, Maribeth, RN, MSN, CEN
P.I. Institution Name:Macon State College
Title:Assistant Professor of Nursing
Contact Address:100 College Station Dr., Macon, GA, 31206 - 5145, USA
Contact Telephone:(478) 471-2903
Clinical Topic: Emergency Departments (ED) overcrowding challenges hospitals across the country and undercuts care to the communities they serve. In 2003, backlogs at this 250-bed hospital in Georgia had become the norm, causing increases in both ground diversion volume and patients that left prior to medical screening exam (LPMSE). ED nurses grew frustrated and patient satisfaction declined. Hospital leadership wanted to know: "What was wrong with the emergency department?" Earlier tracking of internal data revealed the problems were not ours alone. Admitted ED-holds accounted for much of the overcrowding, because of either unavailable or unstaffed inpatient beds. Thus, in 2005, we led a hospital-wide campaign to raise awareness of ED overcrowding and demonstrate to other departments how they impact ED operations. Our overall goal was to work together as a team to improve ED patient throughput and provide our community with appropriate access to care. Implementation: In February 2005, a team of ED nurses, nurse managers, the director of surgery, admissions and other staff met to discuss ED overcrowding and the idea that all hospital personnel share responsibility for patients, and thus ED requests for service must be viewed accordingly. Sub-teams identified causes of overcrowding, and measured and analyzed relationships between variables such as volume of ground diversion; admission holds as a percent of total volume; rationale for holds; time increments of ED visits and total length of stay; percent of LPMSE; and days the hospital could not accommodate medical-surgical, critical care, and dialysis admissions. Key team members presented findings to nurse managers and the ED physician director for dissemination to their staffs. Multiple operational changes were subsequently made and include the following: holding daily bed board meetings to determine area bed needs, stationing an admission nurse at peak admission times; no longer holding patients for convenience at change-of-shift time, creating a "nurse shift report" that tracks in-house and ground diversion and creating a communications algorithm to clarify priorities should unnecessary blockages occurs. In addition, an electronic system was established to monitor both inpatient holds and rationale for holding, while order sets were created to hasten the admission process. Other changes included revising the faxed patient report form, evaluating patients to determine transfer from ICU beds, implementing daily review by nurse managers of probable discharges, reviewing unit staffing needs to meet patient demands, and reallocating resources as beds become available to prevent ED admission delays. Outcomes: A number of improvements were achieved over a short period of time. From February 2005 to August 2005, the median ED length of stay decreased from 3.5 hours to 3.0 hours, and from May 2005 to August 2005, percentage of admitted holds dropped from 4.33 to 1.31; LPMSE fell from 6% to 4.2%; and ground diversion declined from 18.47 days per month to .63 days per month, gaining particular praise from hospital leadership. Not surprisingly, we found strong correlations between inpatient holds, diversion, and LPMSE rates. One unexpected outcome was the alliance forged between ED and other staff as they came to realize the impact they had on moving ED patients through the system. Recommendations: A systems analysis approach is paramount to identifying departmental sources of ED overcrowding and their relationships to one another. Armed with this information, emergency nurses can engage other departments to help formulate new policies, update existing ones, and effect change, so all members of their communities can be better served.
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.titleRemoving Barriers to Patient Flow: A Systems Analysis Approachen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162921-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Removing Barriers to Patient Flow: A Systems Analysis Approach</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">Smith, Maribeth, RN, MSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Macon State College</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor of Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">100 College Station Dr., Macon, GA, 31206 - 5145, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(478) 471-2903</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">msmith@mail.maconstate.edu</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: Emergency Departments (ED) overcrowding challenges hospitals across the country and undercuts care to the communities they serve. In 2003, backlogs at this 250-bed hospital in Georgia had become the norm, causing increases in both ground diversion volume and patients that left prior to medical screening exam (LPMSE). ED nurses grew frustrated and patient satisfaction declined. Hospital leadership wanted to know: &quot;What was wrong with the emergency department?&quot; Earlier tracking of internal data revealed the problems were not ours alone. Admitted ED-holds accounted for much of the overcrowding, because of either unavailable or unstaffed inpatient beds. Thus, in 2005, we led a hospital-wide campaign to raise awareness of ED overcrowding and demonstrate to other departments how they impact ED operations. Our overall goal was to work together as a team to improve ED patient throughput and provide our community with appropriate access to care. Implementation: In February 2005, a team of ED nurses, nurse managers, the director of surgery, admissions and other staff met to discuss ED overcrowding and the idea that all hospital personnel share responsibility for patients, and thus ED requests for service must be viewed accordingly. Sub-teams identified causes of overcrowding, and measured and analyzed relationships between variables such as volume of ground diversion; admission holds as a percent of total volume; rationale for holds; time increments of ED visits and total length of stay; percent of LPMSE; and days the hospital could not accommodate medical-surgical, critical care, and dialysis admissions. Key team members presented findings to nurse managers and the ED physician director for dissemination to their staffs. Multiple operational changes were subsequently made and include the following: holding daily bed board meetings to determine area bed needs, stationing an admission nurse at peak admission times; no longer holding patients for convenience at change-of-shift time, creating a &quot;nurse shift report&quot; that tracks in-house and ground diversion and creating a communications algorithm to clarify priorities should unnecessary blockages occurs. In addition, an electronic system was established to monitor both inpatient holds and rationale for holding, while order sets were created to hasten the admission process. Other changes included revising the faxed patient report form, evaluating patients to determine transfer from ICU beds, implementing daily review by nurse managers of probable discharges, reviewing unit staffing needs to meet patient demands, and reallocating resources as beds become available to prevent ED admission delays. Outcomes: A number of improvements were achieved over a short period of time. From February 2005 to August 2005, the median ED length of stay decreased from 3.5 hours to 3.0 hours, and from May 2005 to August 2005, percentage of admitted holds dropped from 4.33 to 1.31; LPMSE fell from 6% to 4.2%; and ground diversion declined from 18.47 days per month to .63 days per month, gaining particular praise from hospital leadership. Not surprisingly, we found strong correlations between inpatient holds, diversion, and LPMSE rates. One unexpected outcome was the alliance forged between ED and other staff as they came to realize the impact they had on moving ED patients through the system. Recommendations: A systems analysis approach is paramount to identifying departmental sources of ED overcrowding and their relationships to one another. Armed with this information, emergency nurses can engage other departments to help formulate new policies, update existing ones, and effect change, so all members of their communities can be better served.</td></tr></table>en_GB
dc.date.available2011-10-27T10:36:27Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:36:27Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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