2.50
Hdl Handle:
http://hdl.handle.net/10755/198307
Title:
Sustainable Improvement of Emergency Department Patient Throughput
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Sustainable Improvement of Emergency Department Patient Throughput

Purpose: Multiple evidence based practices have been developed to combat the overcrowding of Emergency Departments across the nation (Zun, 2009). Successful implementation of evidence based practice on Emergency Department throughput demands a culture change as well as adoption of new practices. The theoretical approach to the process of change adopted in this study is Diffusion of Innovations by Rogers (2003). Diffusion of Innovations is a theory of how, why and at what rate new ideas and technology spread through cultures. The purpose of this study is to examine the efficacy and sustainability of a staged, interdisciplinary approach to decreasing total average turnaround (TAT) times in the Emergency Department based on the Diffusion of Innovation Theory (Rogers, 2003).

Design: Retrospective quasi experimental time series design of Emergency Department data. Data collection occurred before and after implementation of a series of evidence based practice changes over a 30, 60 and 90 day period with a goal of achieving a 130 minute TAT. Each 30 day period focused on specific areas of the hospital adopting evidence based practice measures.

Setting: A 208-bed facility with a 21 room newly designated Level III Trauma Center, which includes an 8-bed observation unit and a dedicated SANE examination room was the setting for the research. The hospital serves a suburban North Texas community. In 2010, 68% of patients admitted to the hospital arrived via the Emergency Department. The average Emergency Department volume is 40,000 patients per year with an admission rate of 26.5%.

Participants: The sample size included 81,009 patients who visited the Emergency Department between November 2008 and November 2010. In order to protect human subjects, no patient identifiers were used. Data was collected only on throughput indicator times, census and acuity levels.

Methods: Utilizing an electronic data collection tool called the ED Dashboard, throughput times, census, EMS volume and patient acuity were recorded and analyzed. Pre-implementation throughput data was compared to post intervention data, controlling for EMS volume and patient acuity levels (as measured by the Emergency Severity Index (ESI).

Results: Implementation of a successful diffusion of multiple technologies and processes has resulted in an overall improvement of throughput times sustained over a one year period. Implementation of the staged approach to ED throughput led to a decrease in total average turnaround time from 186 minutes to 159 minutes for all Emergency Department patients compared to the previous year. Additionally, average turnaround time for admitted patients decreased from 297 minutes to 222 minutes in this same time period. These results were achieved despite an increased acuity level and an increase in EMS volume.

Implications: Utilization of a staged theoretical approach to culture change as well as adoption of new practices can be successfully applied to improving Emergency Department throughput times.
Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleSustainable Improvement of Emergency Department Patient Throughputen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198307-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Sustainable Improvement of Emergency Department Patient Throughput <br/><br/>Purpose: Multiple evidence based practices have been developed to combat the overcrowding of Emergency Departments across the nation (Zun, 2009). Successful implementation of evidence based practice on Emergency Department throughput demands a culture change as well as adoption of new practices. The theoretical approach to the process of change adopted in this study is Diffusion of Innovations by Rogers (2003). Diffusion of Innovations is a theory of how, why and at what rate new ideas and technology spread through cultures. The purpose of this study is to examine the efficacy and sustainability of a staged, interdisciplinary approach to decreasing total average turnaround (TAT) times in the Emergency Department based on the Diffusion of Innovation Theory (Rogers, 2003). <br/><br/>Design: Retrospective quasi experimental time series design of Emergency Department data. Data collection occurred before and after implementation of a series of evidence based practice changes over a 30, 60 and 90 day period with a goal of achieving a 130 minute TAT. Each 30 day period focused on specific areas of the hospital adopting evidence based practice measures. <br/><br/>Setting: A 208-bed facility with a 21 room newly designated Level III Trauma Center, which includes an 8-bed observation unit and a dedicated SANE examination room was the setting for the research. The hospital serves a suburban North Texas community. In 2010, 68% of patients admitted to the hospital arrived via the Emergency Department. The average Emergency Department volume is 40,000 patients per year with an admission rate of 26.5%. <br/><br/>Participants: The sample size included 81,009 patients who visited the Emergency Department between November 2008 and November 2010. In order to protect human subjects, no patient identifiers were used. Data was collected only on throughput indicator times, census and acuity levels. <br/><br/>Methods: Utilizing an electronic data collection tool called the ED Dashboard, throughput times, census, EMS volume and patient acuity were recorded and analyzed. Pre-implementation throughput data was compared to post intervention data, controlling for EMS volume and patient acuity levels (as measured by the Emergency Severity Index (ESI). <br/><br/>Results: Implementation of a successful diffusion of multiple technologies and processes has resulted in an overall improvement of throughput times sustained over a one year period. Implementation of the staged approach to ED throughput led to a decrease in total average turnaround time from 186 minutes to 159 minutes for all Emergency Department patients compared to the previous year. Additionally, average turnaround time for admitted patients decreased from 297 minutes to 222 minutes in this same time period. These results were achieved despite an increased acuity level and an increase in EMS volume.<br/><br/>Implications: Utilization of a staged theoretical approach to culture change as well as adoption of new practices can be successfully applied to improving Emergency Department throughput times. <br/>en_GB
dc.date.available2011-12-21T12:45:43Z-
dc.date.issued2011-12-21T12:45:43Z-
dc.date.accessioned2011-12-21T12:45:43Z-
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