2.50
Hdl Handle:
http://hdl.handle.net/10755/306604
Category:
Abstract
Type:
Poster
Title:
Let It Flow: Emergency Department Gridlock, A Five Year Perspective
Author(s):
Carlstedt, Ruth; Lawson, Jennifer
Lead Author STTI Affiliation:
Non-member
Author Details:
Ruth Carlstedt, MSN, RN, ruth.carlstedt61@gmail.com; Jennifer Lawson, BSN, RN
Abstract:

Evidence-based Practice Abstract

Purpose: To identify a process that would improve emergency department throughput as evidenced by decrease length of stay (LOS), door to doctor time, diversion hours, and patients categorized as “left without being seen” (LWBS).

Design: This was a staff developed process improvement project.

Setting: A 380-bed community hospital, with a 36 bed emergency department. The emergency department is a cardiac and stroke receiving center and a paramedic base station with 64,000 emergency visits annually.

Participants: Emergency department nurses, physicians, and technicians. Metrics related to emergency department throughput were collected from patient visits from 2007 through 2012.

Methods: A flow team and medical screening process were implemented. The flow team was comprised of the flow nurse, physicians, a second nurse, and a patient care technician. The flow nurse organized patient care after triage and before treatment. In the medical screening process, patients were taken from triage to a screening area for an initial examination and assessment by the physician. A determination of whether they required immediate medical intervention, were stable to wait, or ready for immediate discharge was made. Diagnostics were completed while patients waited in the lobby. Incremental evaluations were conducted at monthly meetings prompting process changes. The hospitals electronic charting system, Meditech, captured numerical data to measure outcomes including door to doctor time, number of patients who left without being seen, length of stay in the department, and diversion hours.

Results/Outcomes: Over the five-year period, the flow team and medical screening process improved emergency department throughput significantly. Door to doctor times, diversion hours, and patients who left without being seen decreased. Most significantly, door to doctor time decreased from a high of 95 minutes to the current average of 36 minutes. Diversion hours went from 140 in 2007 to 25.7 hours in 2012. Patients who left without being seen decreased from a high of 3.2% to less than 1%. Length of stay in the department remained consistent. However, this is considered a positive factor since the yearly volume has risen by 15,000 patients per year in the last five years.

Implications: Use of a medical screening process and a flow team assisted patient throughput and insured rooms were available for acute patients upon arrival and allowed more time the evaluation by the emergency department physicians. Implementation of a process for discharge of non-acute patients after medical screening continues to be a challenge for the flow team. A process for “fast track to discharge” (FTD) is currently being trialed. Throughout this five-year process the emergency department staff has found that improving patient throughput in the emergency department is an ongoing process that requires teamwork and dedication.

Keywords:
Improving ED Throughput
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.titleLet It Flow: Emergency Department Gridlock, A Five Year Perspectiveen_GB
dc.contributor.authorCarlstedt, Ruthen_GB
dc.contributor.authorLawson, Jenniferen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsRuth Carlstedt, MSN, RN, ruth.carlstedt61@gmail.com; Jennifer Lawson, BSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306604-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: To identify a process that would improve emergency department throughput as evidenced by decrease length of stay (LOS), door to doctor time, diversion hours, and patients categorized as “left without being seen” (LWBS).</p><p>Design: This was a staff developed process improvement project.</p><p>Setting: A 380-bed community hospital, with a 36 bed emergency department. The emergency department is a cardiac and stroke receiving center and a paramedic base station with 64,000 emergency visits annually. </p><p>Participants: Emergency department nurses, physicians, and technicians. Metrics related to emergency department throughput were collected from patient visits from 2007 through 2012.</p><p>Methods: A flow team and medical screening process were implemented. The flow team was comprised of the flow nurse, physicians, a second nurse, and a patient care technician. The flow nurse organized patient care after triage and before treatment. In the medical screening process, patients were taken from triage to a screening area for an initial examination and assessment by the physician. A determination of whether they required immediate medical intervention, were stable to wait, or ready for immediate discharge was made. Diagnostics were completed while patients waited in the lobby. Incremental evaluations were conducted at monthly meetings prompting process changes. The hospitals electronic charting system, Meditech, captured numerical data to measure outcomes including door to doctor time, number of patients who left without being seen, length of stay in the department, and diversion hours.</p><p>Results/Outcomes: Over the five-year period, the flow team and medical screening process improved emergency department throughput significantly. Door to doctor times, diversion hours, and patients who left without being seen decreased. Most significantly, door to doctor time decreased from a high of 95 minutes to the current average of 36 minutes. Diversion hours went from 140 in 2007 to 25.7 hours in 2012. Patients who left without being seen decreased from a high of 3.2% to less than 1%. Length of stay in the department remained consistent. However, this is considered a positive factor since the yearly volume has risen by 15,000 patients per year in the last five years.</p><p>Implications: Use of a medical screening process and a flow team assisted patient throughput and insured rooms were available for acute patients upon arrival and allowed more time the evaluation by the emergency department physicians. Implementation of a process for discharge of non-acute patients after medical screening continues to be a challenge for the flow team. A process for “fast track to discharge” (FTD) is currently being trialed. Throughout this five-year process the emergency department staff has found that improving patient throughput in the emergency department is an ongoing process that requires teamwork and dedication.</p>en_GB
dc.subjectImproving ED Throughputen_GB
dc.date.available2013-12-09T17:00:37Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:37Z-
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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