Use of Rapid Treatment and Disposition to Decompress in the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/198297
Title:
Use of Rapid Treatment and Disposition to Decompress in the Emergency Department
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Use of Rapid Treatment and Disposition to Decompress the Emergency Department

Purpose: Increased volume and crowding of Emergency Departments has put an amazing strain on this precious resource. Increasing patient volume in emergency departments across the country continue to generate a need to find creative ways of improving patient flow management. The goal of this project was develop innovative ways to decrease the length of stay for certain types of patients presenting to the Emergency Department.

Design: In using the five-step process improvement model of define, measure, analyze, improve, and control, efforts to reduce length of staff focused on patient throughput targeting patients with chief complaints in which their disposition would result in being “Treated and Released”.

Setting: Urban Level I Emergency Department with over 70,000 annual visits

Participants/Subjects: Medical and Nursing ED Leadership, Emergency Department Staff, Patient Visitor Relations, Performance Services

Methods: The treated and released patient population was analyzed. Using the electronic information system, many “critical X’s” (Arrival by hour, arrival by day of week, acuity level, chief complaint, ED census, Nurse staffing, Provider staffing, etc.) were assessed. Two main initiatives were identified and prioritized by the team:

1. The placement of a Nurse Practioner directly in the triage area.
2. The development of an 8 bay clinical area up-front and adjacent to the triage/registration area. (The rapid Treatment and Dispostion Area)

Results/Outcomes: The two process improvement strategies using structural critical thinking were implemented. The first strategy focused on having the Nurse Practitioner treat all ESI level 4 and 5 patients that presented to triage at designated times and days. This occurred directly in the triage area with the patient never leaving triage with the exception of being taken for a radiologic study. The second strategy was to have a specified team of Nurse and Medical Providers working collaboratively in the 8 bay rapid treatment and disposition area. Here, the team focused on a protocol driven ESI Level 3 patient population as well as an ESI level 4 patient population who required additional procedures. The initial results were very impressive. Data showed that patients that arrived at the same time of day, same day of week, and had the same ESI level had a significant change in their length of stay. Patients seen in the Rapid Treatment Area saw a 91 minute decrease in the “provider evaluation to disposition time” and 29 minute decrease in “disposition to discharge time”. Patients seen by the Nurse Practitioner saw very similar decreases in “evaluation to disposition” and “disposition to discharge times.”

Implications: Based on the data above, the two initiatives have clearly demonstrated great success. The next steps are to move more aggressively in terms of 24 hour/7 day a week coverage. It is clear that a focus on ESI specific patient populations with a dedicated multidisciplinary team can have a significant effect on patient length of stay, thus affording the ability to see more patients within the same amount of time.



Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleUse of Rapid Treatment and Disposition to Decompress in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/198297-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Use of Rapid Treatment and Disposition to Decompress the Emergency Department <br/><br/>Purpose: Increased volume and crowding of Emergency Departments has put an amazing strain on this precious resource. Increasing patient volume in emergency departments across the country continue to generate a need to find creative ways of improving patient flow management. The goal of this project was develop innovative ways to decrease the length of stay for certain types of patients presenting to the Emergency Department.<br/><br/>Design: In using the five-step process improvement model of define, measure, analyze, improve, and control, efforts to reduce length of staff focused on patient throughput targeting patients with chief complaints in which their disposition would result in being “Treated and Released”. <br/><br/>Setting: Urban Level I Emergency Department with over 70,000 annual visits<br/><br/>Participants/Subjects: Medical and Nursing ED Leadership, Emergency Department Staff, Patient Visitor Relations, Performance Services<br/><br/>Methods: The treated and released patient population was analyzed. Using the electronic information system, many “critical X’s” (Arrival by hour, arrival by day of week, acuity level, chief complaint, ED census, Nurse staffing, Provider staffing, etc.) were assessed. Two main initiatives were identified and prioritized by the team: <br/><br/>1. The placement of a Nurse Practioner directly in the triage area.<br/>2. The development of an 8 bay clinical area up-front and adjacent to the triage/registration area. (The rapid Treatment and Dispostion Area)<br/><br/>Results/Outcomes: The two process improvement strategies using structural critical thinking were implemented. The first strategy focused on having the Nurse Practitioner treat all ESI level 4 and 5 patients that presented to triage at designated times and days. This occurred directly in the triage area with the patient never leaving triage with the exception of being taken for a radiologic study. The second strategy was to have a specified team of Nurse and Medical Providers working collaboratively in the 8 bay rapid treatment and disposition area. Here, the team focused on a protocol driven ESI Level 3 patient population as well as an ESI level 4 patient population who required additional procedures. The initial results were very impressive. Data showed that patients that arrived at the same time of day, same day of week, and had the same ESI level had a significant change in their length of stay. Patients seen in the Rapid Treatment Area saw a 91 minute decrease in the “provider evaluation to disposition time” and 29 minute decrease in “disposition to discharge time”. Patients seen by the Nurse Practitioner saw very similar decreases in “evaluation to disposition” and “disposition to discharge times.”<br/><br/>Implications: Based on the data above, the two initiatives have clearly demonstrated great success. The next steps are to move more aggressively in terms of 24 hour/7 day a week coverage. It is clear that a focus on ESI specific patient populations with a dedicated multidisciplinary team can have a significant effect on patient length of stay, thus affording the ability to see more patients within the same amount of time. <br/><br/><br/><br/>en_GB
dc.date.available2011-12-21T12:45:12Z-
dc.date.issued2011-12-21T12:45:12Z-
dc.date.accessioned2011-12-21T12:45:12Z-
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