2.50
Hdl Handle:
http://hdl.handle.net/10755/306612
Category:
Abstract
Type:
Poster
Title:
Disaster Averted: Low Acuity Flow Frees Resources for the Sick
Author(s):
Adams, Kim; Tuke, Erica
Lead Author STTI Affiliation:
Non-member
Author Details:
Kim Adams, RN, kimberlyadams@myfrontiermail.com; Erica Tuke, BSN, RN, CEN
Abstract:

Evidence-based Practice Abstract

Purpose: The project objective was to implement quality, timely, efficient care for low acuity patients in a high acuity emergency department (ED), thus freeing up resources for sicker patients. The “they can wait” paradigm had beds choked with low acuity patients and sick patients unattended in the waiting room. The project was limited to patients with Emergency Severity Index (ESI) rating of 4 and 5 but it was understood there would be flow-on benefits to all patients.

Design: This was a clinical process improvement project utilizing iterative cycles of data review, staff education and rapid cycle improvement trials. The project was led by the ED manager, clinical supervisor and medical director with support by an internal process improvement consultant. Systems’ thinking was employed throughout the project.

Setting: The ED was within a cardiovascular and neuroscience center with average annual visits of 20,000 patients and an admission rate of 25-30%. The ESI 4&5 volume averaged 38% or 1.5 patient arrivals per hour.

Participants/Subjects: Project participants included all arrivals assigned ESI 4&5. Aggregate, de-identified data only was studied. There was no actual or potential danger to patients, only benefits from improved care.

Methods: Iterative Plan-Do-Study-Act cycles over an 18 month period were employed. Data analysis included arrival rates by hour of day, length of stay (LOS) of all patients with the ESI 4&5 group segmented and study of current process for low acuity patients (including time study of 4 time segments: arrival to bed, bed to doctor, doctor to disposition, disposition to departure). Goals were set. Front line staff team was created. Systems analysis of leadership, culture, teams and cross-departmental relationships was performed throughout. Trials of process re-design were conducted.

Results/Outcomes: The specific set goals were achieved: median 90 minute LOS for the ESI 4&5 population, arrival to seeing the doctor of 15 minutes or less, and volume of patients who left without being seen of 1% or less. Further achievements included process changes involving establishment of 2 “sitting spaces” (i.e. no bed), team practice pattern changes, efficient deployment of supplies and equipment, triage re-design, charge nurse role re-design, and establishment of team norms.

Implications: This project had wide implications for the ED. By having 38% of the overall volume managed efficiently, beds were freed for sicker patients and the whole ED managed their patient population much more efficiently. Ambulance diversion was eliminated, the waiting room was empty 90% of the time and the staff adopted “continuous process improvement” thus sustained their gains. Overall LOS was reduced to 120 minutes for discharged patients, all acuities. Recommendations include addressing low acuity flow as a powerful way to impact overall ED performance (even in high acuity EDs), including systems’ thinking in all process improvement work and managing socio- cultural issues as aggressively as process improvement in order to achieve long term success.

Presenters, non-authors: Edie Newell, MSN, RN and McKenzie Williams, MSN, RN, CEN

Keywords:
Low Acuity Flow
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.titleDisaster Averted: Low Acuity Flow Frees Resources for the Sicken_GB
dc.contributor.authorAdams, Kimen_GB
dc.contributor.authorTuke, Ericaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsKim Adams, RN, kimberlyadams@myfrontiermail.com; Erica Tuke, BSN, RN, CENen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306612-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: The project objective was to implement quality, timely, efficient care for low acuity patients in a high acuity emergency department (ED), thus freeing up resources for sicker patients. The “they can wait” paradigm had beds choked with low acuity patients and sick patients unattended in the waiting room. The project was limited to patients with Emergency Severity Index (ESI) rating of 4 and 5 but it was understood there would be flow-on benefits to all patients.</p><p>Design: This was a clinical process improvement project utilizing iterative cycles of data review, staff education and rapid cycle improvement trials. The project was led by the ED manager, clinical supervisor and medical director with support by an internal process improvement consultant. Systems’ thinking was employed throughout the project.</p><p>Setting: The ED was within a cardiovascular and neuroscience center with average annual visits of 20,000 patients and an admission rate of 25-30%. The ESI 4&5 volume averaged 38% or 1.5 patient arrivals per hour.</p><p>Participants/Subjects: Project participants included all arrivals assigned ESI 4&5. Aggregate, de-identified data only was studied. There was no actual or potential danger to patients, only benefits from improved care.</p><p>Methods: Iterative Plan-Do-Study-Act cycles over an 18 month period were employed. Data analysis included arrival rates by hour of day, length of stay (LOS) of all patients with the ESI 4&5 group segmented and study of current process for low acuity patients (including time study of 4 time segments: arrival to bed, bed to doctor, doctor to disposition, disposition to departure). Goals were set. Front line staff team was created. Systems analysis of leadership, culture, teams and cross-departmental relationships was performed throughout. Trials of process re-design were conducted.</p><p>Results/Outcomes: The specific set goals were achieved: median 90 minute LOS for the ESI 4&5 population, arrival to seeing the doctor of 15 minutes or less, and volume of patients who left without being seen of 1% or less. Further achievements included process changes involving establishment of 2 “sitting spaces” (i.e. no bed), team practice pattern changes, efficient deployment of supplies and equipment, triage re-design, charge nurse role re-design, and establishment of team norms.</p><p>Implications: This project had wide implications for the ED. By having 38% of the overall volume managed efficiently, beds were freed for sicker patients and the whole ED managed their patient population much more efficiently. Ambulance diversion was eliminated, the waiting room was empty 90% of the time and the staff adopted “continuous process improvement” thus sustained their gains. Overall LOS was reduced to 120 minutes for discharged patients, all acuities. Recommendations include addressing low acuity flow as a powerful way to impact overall ED performance (even in high acuity EDs), including systems’ thinking in all process improvement work and managing socio- cultural issues as aggressively as process improvement in order to achieve long term success.</p><p>Presenters, non-authors: Edie Newell, MSN, RN and McKenzie Williams, MSN, RN, CEN</p>en_GB
dc.subjectLow Acuity Flowen_GB
dc.date.available2013-12-09T17:00:44Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:44Z-
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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