2.50
Hdl Handle:
http://hdl.handle.net/10755/623653
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
A Split-flow Model for ED Level 3 Patients
Author(s):
Cabello, Brooke; Ruscio, Berta; Patel, Ami; Woodard, Tony; Tipton, Phyllis
Lead Author STTI Affiliation:
Non-member
Author Details:
Brooke Cabello, BSN, RN; Berta Ruscio, RN; Ami Patel, RN; Tony Woodard, MSN, RN, CNS, ACNS-BC, CEN, CMTE, LP; Phyllis Tipton, PhD, RN
Abstract:

Poster presentation

Session J presented Saturday, September 16, 2017

Purpose: Prolonged wait times and length of stays have inundated Emergency Departments(ED) across the nation. Our ED has struggled with these same hurdles over the past few years. Specifically, patients that are assigned emergency severity index (ESI) level 3 have overwhelmed our department by increasing wait times and length of stays (LOS). Therefore, the purpose of this project was to implement a method to decrease the level 3 emergency department discharged patients’ LOS. A secondary purpose was to reduce our left without being seen (LWBS) level 3 patients.

Design: This is a quality improvement project that was conducted over a two month period beginning in October  and carried through November 2016.

Setting: The project took place at our  level one trauma ED located in a academic teaching facility in Central Texas.  Our ED is a 44 bed unit.

Participants/Subjects: Between October and November our total number of patients seen was 9709 of which 4781 were level 3 patients. Inclusion criteria was ESI level 3  patients that could be evaluated in a fast track area requiring three of more interventions such as: labs, imaging, or medications.  Our exclusion criteria was level 3 patients with multiple comorbidities requiring a more complex evaluation in an ED room and likely requiring hospital admission.

Methods: A designated nurse and physician was assigned to run a level 3 focused fast track (FFT) in conjunction with the existing fast track that was managed by advanced practice providers.  Physicians reviewed triage notes and vital signs to decide whether the patient met criteria for our focused fast track. Patients were then escorted to FFT room where standing orders/interventions were performed and a focused assessment by physician and nurse completed. FFT patients taken to pending results area to await completed results. Patient was than either discharged or placed in an ED room for further evaluation.

Results/Outcomes:  Our pre-intervention average LOS for level 3 patients was 262 minutes. Upon implementation of our project the average decreased to 161 minutes. In addition, our LWBS decreased and patient satisfaction scores increased. As supported by a 25% reduction in wait times and LOS for level 3 patients.

Implications: Level 3 patients were systemically and efficiently processed which decreased LOS. Additionally, the decreased LOS contributed to increased patient and staff satisfaction due to decreased workload to the department.  There is a cost savings related to LWBS ($2,000/patient) patients. The average from January to September was 4.33%. LWBS average for October decreased further to 2.44%.  November LWBS decreased to 1.63%.

Keywords:
Length of Stay; Split-flow; Emergency Department
Repository Posting Date:
4-Dec-2017
Date of Publication:
4-Dec-2017
Conference Date:
2017
Conference Name:
Emergency Nursing 2017
Conference Host:
Emergency Nurses Association
Conference Location:
St. Louis, Missouri, USA
Description:
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleA Split-flow Model for ED Level 3 Patientsen_US
dc.contributor.authorCabello, Brookeen
dc.contributor.authorRuscio, Bertaen
dc.contributor.authorPatel, Amien
dc.contributor.authorWoodard, Tonyen
dc.contributor.authorTipton, Phyllisen
dc.contributor.departmentNon-memberen
dc.author.detailsBrooke Cabello, BSN, RN; Berta Ruscio, RN; Ami Patel, RN; Tony Woodard, MSN, RN, CNS, ACNS-BC, CEN, CMTE, LP; Phyllis Tipton, PhD, RNen
dc.identifier.urihttp://hdl.handle.net/10755/623653-
dc.description.abstract<p>Poster presentation</p> <p>Session J presented Saturday, September 16, 2017</p> <p>Purpose: Prolonged wait times and length of stays have inundated Emergency Departments(ED) across the nation. Our ED has struggled with these same hurdles over the past few years. Specifically, patients that are assigned emergency severity index (ESI) level 3 have overwhelmed our department by increasing wait times and length of stays (LOS). Therefore, the purpose of this project was to implement a method to decrease the level 3 emergency department discharged patients&rsquo; LOS. A secondary purpose was to reduce our left without being seen (LWBS) level 3 patients.</p> <p>Design: This is a quality improvement project that was conducted over a two month period beginning in October&nbsp; and carried through November 2016.</p> <p>Setting: The project took place at our&nbsp; level one trauma ED located in a academic teaching facility in Central Texas.&nbsp; Our ED is a 44 bed unit.</p> <p>Participants/Subjects: Between October and November our total number of patients seen was 9709 of which 4781 were level 3 patients. Inclusion criteria was ESI level 3&nbsp; patients that could be evaluated in a fast track area requiring three of more interventions such as: labs, imaging, or medications.&nbsp; Our exclusion criteria was level 3 patients with multiple comorbidities requiring a more complex evaluation in an ED room and likely requiring hospital admission.</p> <p>Methods: A designated nurse and physician was assigned to run a level 3 focused fast track (FFT) in conjunction with the existing fast track that was managed by advanced practice providers.&nbsp; Physicians reviewed triage notes and vital signs to decide whether the patient met criteria for our focused fast track. Patients were then escorted to FFT room where standing orders/interventions were performed and a focused assessment by physician and nurse completed. FFT patients taken to pending results area to await completed results. Patient was than either discharged or placed in an ED room for further evaluation.</p> <p>Results/Outcomes:&nbsp; Our pre-intervention average LOS for level 3 patients was 262 minutes. Upon implementation of our project the average decreased to 161 minutes. In addition, our LWBS decreased and patient satisfaction scores increased. As supported by a 25% reduction in wait times and LOS for level 3 patients.</p> <p>Implications: Level 3 patients were systemically and efficiently processed which decreased LOS. Additionally, the decreased LOS contributed to increased patient and staff satisfaction due to decreased workload to the department.&nbsp; There is a cost savings related to LWBS ($2,000/patient) patients. The average from January to September was 4.33%. LWBS average for October decreased further to 2.44%.&nbsp; November LWBS decreased to 1.63%.</p>en
dc.subjectLength of Stayen
dc.subjectSplit-flowen
dc.subjectEmergency Departmenten
dc.date.available2017-12-04T19:15:20Z-
dc.date.issued2017-12-04-
dc.date.accessioned2017-12-04T19:15:20Z-
dc.conference.date2017en
dc.conference.nameEmergency Nursing 2017en
dc.conference.hostEmergency Nurses Associationen
dc.conference.locationSt. Louis, Missouri, USAen
dc.descriptionENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missourien
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