2.50
Hdl Handle:
http://hdl.handle.net/10755/198331
Title:
Emergency Department Overcrowding: A Multifaceted Approach to Improvement
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation]ED Overcrowding: A Multifaceted Approach to Improvement

Purpose: The purpose of this project was to develop a more patient focused triage process and improve patient flow in an emergency department in a suburban setting in the MidAtlantic region of the United States. Specific goals were to (1) decrease door to ED exam room and door to ED provider times, (2) decrease overall emergency department turn-around time, and (3) improve patient satisfaction as measured by Press Ganey scores.

Design: A committee of emergency department staff nurses was formed to develop the process redesign. A literature search was done for current research articles and site visits were made to other facilities.

Setting: This is a 195 bed suburban hospital with a forty bed emergency department having approximately 53,000 visits per year. Renovations created a six bay rapid treatment and four bay intake area.

Participants: There were two groups of participants. First were patients seeking treatment in the emergency department from July 1 through December 30, 2010. Second were the emergency department registrars, technicians, nurses, and providers.

Methods: Committee members developed the following departmental changes to streamline patient flow and improve the overall patient experience:
1. Triage area was renamed “intake” and staffed by a team including RNs, ED technicians, and providers. No RN or ED tech would be assigned to intake for longer than four hours at a time.
2. Triage was no longer a place but a process with the intake team being mobile.
3. All customers were given VIP treatment, going directly from door to exam area whenever space was available with bedside registration.
4. During times of high volume, patient evaluation and care was initiated by intake team. Other staff could be temporarily assigned to intake.
5. A six bay rapid treatment area was established with a ninety minute or less door to discharge time criteria.
6. The “float nurse” role was redefined as the “flow nurse” with responsibilities in order of priority being a.) discharge patients, b.) expedite transfer of admissions to in-patient areas, and c.) assist other staff.
Prior to implementation, information about the changes was disseminated to staff via email and staff meetings. Initially a core group of staff were assigned to Intake to ensure consistency and then other staff members were “buddied” with them until they demonstrated an understanding of the redefined roles and processes. Changes were simultaneously implemented on July 1, 2010.

Results: This was a very successful project. As compared to Fiscal Year 2010 door to room time was decreased by 9 minutes, door to provider time by 11 minutes and overall ED turn-around time from 250 to 230 minutes. Patient satisfaction scores improved from the 86th to the 97th percentile. This was accomplished despite having ED boarders during several of the months.

Implications: ED overcrowding is a complex problem and cannot be solved with any single “fix”. This project demonstrates that utilizing a patient focused, multifaceted approach to change can have a positive impact and improve the patients’ overall ED experience.




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

Full metadata record

DC FieldValue Language
dc.titleEmergency Department Overcrowding: A Multifaceted Approach to Improvementen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198331-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation]ED Overcrowding: A Multifaceted Approach to Improvement<br/><br/>Purpose: The purpose of this project was to develop a more patient focused triage process and improve patient flow in an emergency department in a suburban setting in the MidAtlantic region of the United States. Specific goals were to (1) decrease door to ED exam room and door to ED provider times, (2) decrease overall emergency department turn-around time, and (3) improve patient satisfaction as measured by Press Ganey scores.<br/><br/>Design: A committee of emergency department staff nurses was formed to develop the process redesign. A literature search was done for current research articles and site visits were made to other facilities. <br/><br/>Setting: This is a 195 bed suburban hospital with a forty bed emergency department having approximately 53,000 visits per year. Renovations created a six bay rapid treatment and four bay intake area.<br/><br/>Participants: There were two groups of participants. First were patients seeking treatment in the emergency department from July 1 through December 30, 2010. Second were the emergency department registrars, technicians, nurses, and providers.<br/><br/>Methods: Committee members developed the following departmental changes to streamline patient flow and improve the overall patient experience:<br/> 1. Triage area was renamed “intake” and staffed by a team including RNs, ED technicians, and providers. No RN or ED tech would be assigned to intake for longer than four hours at a time.<br/> 2. Triage was no longer a place but a process with the intake team being mobile.<br/> 3. All customers were given VIP treatment, going directly from door to exam area whenever space was available with bedside registration.<br/> 4. During times of high volume, patient evaluation and care was initiated by intake team. Other staff could be temporarily assigned to intake.<br/> 5. A six bay rapid treatment area was established with a ninety minute or less door to discharge time criteria. <br/> 6. The “float nurse” role was redefined as the “flow nurse” with responsibilities in order of priority being a.) discharge patients, b.) expedite transfer of admissions to in-patient areas, and c.) assist other staff.<br/>Prior to implementation, information about the changes was disseminated to staff via email and staff meetings. Initially a core group of staff were assigned to Intake to ensure consistency and then other staff members were “buddied” with them until they demonstrated an understanding of the redefined roles and processes. Changes were simultaneously implemented on July 1, 2010.<br/><br/>Results: This was a very successful project. As compared to Fiscal Year 2010 door to room time was decreased by 9 minutes, door to provider time by 11 minutes and overall ED turn-around time from 250 to 230 minutes. Patient satisfaction scores improved from the 86th to the 97th percentile. This was accomplished despite having ED boarders during several of the months.<br/><br/>Implications: ED overcrowding is a complex problem and cannot be solved with any single “fix”. This project demonstrates that utilizing a patient focused, multifaceted approach to change can have a positive impact and improve the patients’ overall ED experience. <br/><br/><br/><br/><br/>en_GB
dc.date.available2011-12-21T12:45:56Z-
dc.date.issued2011-12-21T12:45:56Z-
dc.date.accessioned2011-12-21T12:45:56Z-
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