2.50
Hdl Handle:
http://hdl.handle.net/10755/324169
Category:
Abstract
Type:
Presentation
Title:
Improving Patient Flow
Author(s):
Fulcher, Julie; Brdaric, Therese; Tronsue, Rhonda
Author Details:
Julie Fulcher, MSN, CNS-BC, CE, email: jmfulcher@geisinger.edu; Therese Brdaric, BSN, RN; Rhonda Tronsue, AD, RN
Abstract:
Evidence-based Practice Abstract Purpose: Emergency Department (ED) overcrowding has been an ongoing national barrier to timely patient care, increasing frustrations for both patients and hospital staff. Barriers to patient flow include patient volumes, physical design, resource availability and ED processes. Design: This is a quality assurance project that involved multidisciplinary teams to make a series of changes to the department. Setting: Geisinger Wyoming Valley Medical Center is a 274 bed hospital (including 20 rehabilitation beds at Geisinger-South Wilkes-Barre campus) in an urban area in northeast Pennsylvania. It is a Level II trauma and accredited chest pain center. The ED is a 32 room department with 53,000 visits per year and an admission rate of 19% for fiscal year (FY) 2013. Participants: The project team includes a multidisciplinary approach by various levels of staff and management. Representatives included ED staff, hospital administration, pharmacy, case management, registration and facilities. The team from within the ED was comprised of staff nurses, managers, providers, performance improvement coordinator and educator. Methods: Multiple changes were made between July of 2011 and June 2013 to improve patient throughput in the ED. In the area of triage; direct to bed, registered nurse in triage 24/7, bedside registration, nurse order sets, reinforcement of acuity levels, rapid diagnostic rooms, medication dispensing in triage, and medical screening by a provider was implemented. In the area of admissions; increasing inpatient hospital beds (from 223 to 254), adding a teletracking system, adding a bed coordinator position, earlier transport requests and interdisciplinary rounding. For the redesign; urgent care was opened on campus to divert low acuity patients and fast track was converted into acute care. Three rooms were opened to triage for a rapid diagnostic area. Resources added to the ED; pharmacist, case managers and a roving intensive care nurse (RIC). Results: To measure the effectiveness of the changes made length of stay (LOS), arrival to provider, volumes, elopements and acuity were evaluated. The volumes for FY2011 were 49,020 visits, for 2012 53,525 visits and for 2013 53,682 visits, resulting in a steady increase in volume. LOS for June 2011, prior to the implementation of these changes, was an average of 214 minutes. The LOS for June, 2013 increased to 262 minutes. The volume of acuity level 1’s and 2’s along with boarding hours increased significantly from year 2011 to 2013 affecting the LOS. The time of arrival to medical screening decreased from an average of 68 minutes (June, 2011) and to 30 minutes (June, 2013) when provided in triage. After the urgent care opened, fast track patients decreased from 10,470 (FY2011) to 5,796 (FY2013). There was a reduction in left without being seen (LWBS) from the waiting room from 3.38% to 2.73%. Implications: Multiple implementations were required to make positive effects on patient throughput in the ED. Increasing volumes, acuity levels and boarding hours challenge flow. Placing a provider in triage reduced arrival to provider times and reduced LWBS in the waiting room, but increased elopements from the main ED area.
Keywords:
Patient Flow; Overcrowding
Repository Posting Date:
4-Aug-2014
Date of Publication:
4-Aug-2014
Conference Date:
2014
Conference Name:
2014 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Phoenix, Arizona USA
Description:
2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleImproving Patient Flowen_GB
dc.contributor.authorFulcher, Julieen_GB
dc.contributor.authorBrdaric, Thereseen_GB
dc.contributor.authorTronsue, Rhondaen_GB
dc.author.detailsJulie Fulcher, MSN, CNS-BC, CE, email: jmfulcher@geisinger.edu; Therese Brdaric, BSN, RN; Rhonda Tronsue, AD, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/324169-
dc.description.abstractEvidence-based Practice Abstract Purpose: Emergency Department (ED) overcrowding has been an ongoing national barrier to timely patient care, increasing frustrations for both patients and hospital staff. Barriers to patient flow include patient volumes, physical design, resource availability and ED processes. Design: This is a quality assurance project that involved multidisciplinary teams to make a series of changes to the department. Setting: Geisinger Wyoming Valley Medical Center is a 274 bed hospital (including 20 rehabilitation beds at Geisinger-South Wilkes-Barre campus) in an urban area in northeast Pennsylvania. It is a Level II trauma and accredited chest pain center. The ED is a 32 room department with 53,000 visits per year and an admission rate of 19% for fiscal year (FY) 2013. Participants: The project team includes a multidisciplinary approach by various levels of staff and management. Representatives included ED staff, hospital administration, pharmacy, case management, registration and facilities. The team from within the ED was comprised of staff nurses, managers, providers, performance improvement coordinator and educator. Methods: Multiple changes were made between July of 2011 and June 2013 to improve patient throughput in the ED. In the area of triage; direct to bed, registered nurse in triage 24/7, bedside registration, nurse order sets, reinforcement of acuity levels, rapid diagnostic rooms, medication dispensing in triage, and medical screening by a provider was implemented. In the area of admissions; increasing inpatient hospital beds (from 223 to 254), adding a teletracking system, adding a bed coordinator position, earlier transport requests and interdisciplinary rounding. For the redesign; urgent care was opened on campus to divert low acuity patients and fast track was converted into acute care. Three rooms were opened to triage for a rapid diagnostic area. Resources added to the ED; pharmacist, case managers and a roving intensive care nurse (RIC). Results: To measure the effectiveness of the changes made length of stay (LOS), arrival to provider, volumes, elopements and acuity were evaluated. The volumes for FY2011 were 49,020 visits, for 2012 53,525 visits and for 2013 53,682 visits, resulting in a steady increase in volume. LOS for June 2011, prior to the implementation of these changes, was an average of 214 minutes. The LOS for June, 2013 increased to 262 minutes. The volume of acuity level 1’s and 2’s along with boarding hours increased significantly from year 2011 to 2013 affecting the LOS. The time of arrival to medical screening decreased from an average of 68 minutes (June, 2011) and to 30 minutes (June, 2013) when provided in triage. After the urgent care opened, fast track patients decreased from 10,470 (FY2011) to 5,796 (FY2013). There was a reduction in left without being seen (LWBS) from the waiting room from 3.38% to 2.73%. Implications: Multiple implementations were required to make positive effects on patient throughput in the ED. Increasing volumes, acuity levels and boarding hours challenge flow. Placing a provider in triage reduced arrival to provider times and reduced LWBS in the waiting room, but increased elopements from the main ED area.en_GB
dc.subjectPatient Flowen_GB
dc.subjectOvercrowdingen_GB
dc.date.available2014-08-04T13:28:45Z-
dc.date.issued2014-08-04-
dc.date.accessioned2014-08-04T13:28:45Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationPhoenix, Arizona USAen_GB
dc.description2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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