2.50
Hdl Handle:
http://hdl.handle.net/10755/344131
Category:
Abstract
Type:
Poster
Title:
Reimagining ED Front End Care
Author(s):
Scott, Robin; Koehler, April; Prevost, Stephanie; Schimpf, Brandi
Lead Author STTI Affiliation:
Non-member
Author Details:
Robin Scott, MS, RN, CEN, robin.scott@uchealth.org; April Koehler, BSN, RN; Stephanie Prevost, RN, CEN; Brandi Schimpf, BSN, RN, CEN
Abstract:
Evidence-based Practice Abstract Purpose: Overcrowding, patient safety, and inpatient boarding are all problems that Emergency Department (ED) administrators are tasked with overcoming on a daily basis. The Centers for Disease Control (CDC) reports that in 2010 there were 129.8 million emergency department (ED) visits in the United States; only 25.1% of those patients were seen by a physician or mid-level provider within 15 minutes of arrival. This project grew roots from a move to a new physical ED space. The primary focus was to improve the efficiency of patient flow through the department, improve patient safety and decrease patient wait times. Design: This was a process/quality improvement project. Setting: Emergency Department in an academic/teaching institution, 500 bed Level II Trauma Center on pace to see 90,000 patients in FY 2014. Participants/Subjects: All ED patients, staff and physicians. Methods: A literature review was completed on the subject of ED front end operations. After best practices were reviewed, a LEAN methodology was used to construct a multidisciplinary Rapid Process Module (RPM). From this interprofessional meeting a new front end process was developed and tested. Testing included multiple tabletop exercises to stress the process with high patient census and running scenarios with live simulated patients and staff. Data and individual feedback was used to re-inform the new process and refine it. Orientation and training took place over several months and included staff walk throughs, equipment training, process training and emergent patient scenarios. The new process implements a two tiered triage approach, a first line Pivot Team initially greets and screens walk-in patients with a disaster style triage, designating a patient as sick or not sick. The Pivot process takes 2-3 minutes, no vital signs or medical history is obtained by the pivot team. From Pivot, ‘sick’ patients are directly roomed and ‘not sick’ are sent to an Intake Room. When in Intake the patient is seen by a physician who conducts a medical screening exam, initiates orders based upon the patient’s presentation, and the patient is then roomed directly from the Intake point. Results/Outcomes: In a matter of 3 weeks we saw a 12% increase in our ED census, while at the same time decreasing arrival to physician time by 55%, decreasing the number of patients who left without being seen to 0 and decreasing our average length of stay by 39%. Additionally, the department has not logged any ambulance divert hours since the move and the change in patient arrival process. Implications: Throughout this process the ability to keep some flexibility in defining the new processes was an important focus. As processes were implemented staff feedback brought to light the need for changes to further improve workflows. The need to work with physicians partners to match staffing for peak patient times is needed. Development of a saturation plan is needed regardless of the size of the ED. Finally the need to re-design the process/workflow prior to redesigning the physical layout is key in implementing the new process without requiring later process redesigns.
Keywords:
ED Front End Care; ED Patient Flow
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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.typePosteren_GB
dc.titleReimagining ED Front End Careen_GB
dc.contributor.authorScott, Robinen_GB
dc.contributor.authorKoehler, Aprilen_GB
dc.contributor.authorPrevost, Stephanieen_GB
dc.contributor.authorSchimpf, Brandien_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsRobin Scott, MS, RN, CEN, robin.scott@uchealth.org; April Koehler, BSN, RN; Stephanie Prevost, RN, CEN; Brandi Schimpf, BSN, RN, CENen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344131-
dc.description.abstractEvidence-based Practice Abstract Purpose: Overcrowding, patient safety, and inpatient boarding are all problems that Emergency Department (ED) administrators are tasked with overcoming on a daily basis. The Centers for Disease Control (CDC) reports that in 2010 there were 129.8 million emergency department (ED) visits in the United States; only 25.1% of those patients were seen by a physician or mid-level provider within 15 minutes of arrival. This project grew roots from a move to a new physical ED space. The primary focus was to improve the efficiency of patient flow through the department, improve patient safety and decrease patient wait times. Design: This was a process/quality improvement project. Setting: Emergency Department in an academic/teaching institution, 500 bed Level II Trauma Center on pace to see 90,000 patients in FY 2014. Participants/Subjects: All ED patients, staff and physicians. Methods: A literature review was completed on the subject of ED front end operations. After best practices were reviewed, a LEAN methodology was used to construct a multidisciplinary Rapid Process Module (RPM). From this interprofessional meeting a new front end process was developed and tested. Testing included multiple tabletop exercises to stress the process with high patient census and running scenarios with live simulated patients and staff. Data and individual feedback was used to re-inform the new process and refine it. Orientation and training took place over several months and included staff walk throughs, equipment training, process training and emergent patient scenarios. The new process implements a two tiered triage approach, a first line Pivot Team initially greets and screens walk-in patients with a disaster style triage, designating a patient as sick or not sick. The Pivot process takes 2-3 minutes, no vital signs or medical history is obtained by the pivot team. From Pivot, ‘sick’ patients are directly roomed and ‘not sick’ are sent to an Intake Room. When in Intake the patient is seen by a physician who conducts a medical screening exam, initiates orders based upon the patient’s presentation, and the patient is then roomed directly from the Intake point. Results/Outcomes: In a matter of 3 weeks we saw a 12% increase in our ED census, while at the same time decreasing arrival to physician time by 55%, decreasing the number of patients who left without being seen to 0 and decreasing our average length of stay by 39%. Additionally, the department has not logged any ambulance divert hours since the move and the change in patient arrival process. Implications: Throughout this process the ability to keep some flexibility in defining the new processes was an important focus. As processes were implemented staff feedback brought to light the need for changes to further improve workflows. The need to work with physicians partners to match staffing for peak patient times is needed. Development of a saturation plan is needed regardless of the size of the ED. Finally the need to re-design the process/workflow prior to redesigning the physical layout is key in implementing the new process without requiring later process redesigns.en_GB
dc.subjectED Front End Careen_GB
dc.subjectED Patient Flowen_GB
dc.date.available2015-02-04T11:27:03Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:03Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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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