2.50
Hdl Handle:
http://hdl.handle.net/10755/306581
Category:
Abstract
Type:
Poster
Title:
Tackling Emergency Department Overcrowding, a Success Story
Author(s):
Leckie, Maureen; Novotny, April; Carter, Pam
Lead Author STTI Affiliation:
Non-member
Author Details:
Maureen Leckie, BSN, RN, maureen.leckie@lrmc.com; April Novotny, MSN, RN, CEN; Pam Carter, BSN, RN
Abstract:

Evidence-based Practice Abstract

Purpose: Emergency departments throughout the nation are challenged with overcrowding and long lengths of stays. As Florida’s busiest ED, it was imperative to address these issues that had created a “chaotic” environment for staff, physicians, and patients. A new ED workflow that would improve throughput not only in the ED, but organizationally by utilizing data and metrics to define goals, and drive outcomes focused on the patient experience was needed. This medical center sought to redesign the ED processes and flow to accommodate a volume greater than 160,000, while keeping patients leaving without treatment under 0.5% and turnaround times under 3 hours while maintaining caring and quality outcomes for the patient.

Design: A multidisciplinary team embarked on an 18 month project to identify each step of the process for the patient and delays or waits that occurred for this quality improvement project. A pod design replaced the protocol driven critical care and intermediate care areas of the department to allow for full utilization of beds. A Bed Traffic Control position assigns all incoming patients including EMS on a rotational basis to each pod. Each pod has a designated ED physician, RN staff and clinical supervisor to ensure an efficient flow for the patient. Inpatient units identify a “bed ahead” so that admits are not held in the ED.

Setting: Urban 851 licensed bed medical facility. The Emergency department is a level 2 trauma center with 105 beds and over 167,000 annual visits in FY 2012.

Participants: A retrospective review of patient volumes (approx. 150,000 visits) was completed to determine pattern of arrivals, length of stays, and bed utilization.

Methods: A multidisciplinary team including all ancillary departments such as patient placement, radiology, lab, environmental, respiratory teamed with the ED staff and leadership and met every two weeks to identify each department’s desired state. Goals were set for processes that impacted the patients ED turnaround time. Flows were examined for improvement opportunities and rapid cycle changes were designed. Weekly data reported and openly shared to promote transparency and needed collaboration for improvement.

Results: A culture of rapid cycle change is embraced by staff and physicians. CMS hospital compare website data for January - March 2012, reveals the average turnaround time for door to admit is195 minutes while the national average is 277 minutes. Left without treatment is currently 0.4%, admission bed request to assign 12 minutes with no inpatient holds or delays for EMS patients to be assigned an ED bed.

Implications: This successful project supports collaborative changes that can be made both in the ED and hospital to improve overcrowding in the ED and improves safety and outcomes for patients with decreased turnaround times, and decreased left without treatment rates. This process of change can be replicated in other EDs by developing a multidisciplinary team approach that defines goals, examines current processes and identifies the desired state. Implementation of pods with universal bedding allows for greater utilization of beds and better efficiency.

Keywords:
ED Overcrowding
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleTackling Emergency Department Overcrowding, a Success Storyen_GB
dc.contributor.authorLeckie, Maureenen_GB
dc.contributor.authorNovotny, Aprilen_GB
dc.contributor.authorCarter, Pamen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsMaureen Leckie, BSN, RN, maureen.leckie@lrmc.com; April Novotny, MSN, RN, CEN; Pam Carter, BSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306581-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Emergency departments throughout the nation are challenged with overcrowding and long lengths of stays. As Florida’s busiest ED, it was imperative to address these issues that had created a “chaotic” environment for staff, physicians, and patients. A new ED workflow that would improve throughput not only in the ED, but organizationally by utilizing data and metrics to define goals, and drive outcomes focused on the patient experience was needed. This medical center sought to redesign the ED processes and flow to accommodate a volume greater than 160,000, while keeping patients leaving without treatment under 0.5% and turnaround times under 3 hours while maintaining caring and quality outcomes for the patient.</p><p>Design: A multidisciplinary team embarked on an 18 month project to identify each step of the process for the patient and delays or waits that occurred for this quality improvement project. A pod design replaced the protocol driven critical care and intermediate care areas of the department to allow for full utilization of beds. A Bed Traffic Control position assigns all incoming patients including EMS on a rotational basis to each pod. Each pod has a designated ED physician, RN staff and clinical supervisor to ensure an efficient flow for the patient. Inpatient units identify a “bed ahead” so that admits are not held in the ED.</p><p>Setting: Urban 851 licensed bed medical facility. The Emergency department is a level 2 trauma center with 105 beds and over 167,000 annual visits in FY 2012.</p><p>Participants: A retrospective review of patient volumes (approx. 150,000 visits) was completed to determine pattern of arrivals, length of stays, and bed utilization.</p><p>Methods: A multidisciplinary team including all ancillary departments such as patient placement, radiology, lab, environmental, respiratory teamed with the ED staff and leadership and met every two weeks to identify each department’s desired state. Goals were set for processes that impacted the patients ED turnaround time. Flows were examined for improvement opportunities and rapid cycle changes were designed. Weekly data reported and openly shared to promote transparency and needed collaboration for improvement.</p><p>Results: A culture of rapid cycle change is embraced by staff and physicians. CMS hospital compare website data for January - March 2012, reveals the average turnaround time for door to admit is195 minutes while the national average is 277 minutes. Left without treatment is currently 0.4%, admission bed request to assign 12 minutes with no inpatient holds or delays for EMS patients to be assigned an ED bed.</p><p>Implications: This successful project supports collaborative changes that can be made both in the ED and hospital to improve overcrowding in the ED and improves safety and outcomes for patients with decreased turnaround times, and decreased left without treatment rates. This process of change can be replicated in other EDs by developing a multidisciplinary team approach that defines goals, examines current processes and identifies the desired state. Implementation of pods with universal bedding allows for greater utilization of beds and better efficiency.</p>en_GB
dc.subjectED Overcrowdingen_GB
dc.date.available2013-12-09T17:00:10Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:10Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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