ED management : the monthly update on emergency department management
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With volume and the left-without-being-seen (LWBS) rate on the increase, Mercy Hospital in Springfield, MO, created a new ED flow facilitator position to take charge of throughput. The ED flow facilitator is a nurse who assigns patients to the east and west zones of the department, and also handles all ambulance calls. The approach has helped the ED bring the LWBS rate from 8% to the 3% to 5% range, and it has also made a dent in length-of-stay and door-to-bed times, but rising volume continues to be a challenge. ⋯ Good flow facilitators are nurses with supervisor potential who typically prefer to stay involved with nursing care. They need to be able to multi-task and handle high levels of stress. Hospital administrators note that patient flow patterns need to be under constant review in order to fashion solutions that make sense for the ED.
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Recognizing that sepsis is the leading cause of death in hospitalized patients and a huge drain on health care resources, The Joint Commission's Center for Transforming Health Care, is taking aim at the problem in a new project that is already underway. Six participating health care systems are working to develop a targeted solutions tool that Joint Commission members can use to reduce the incidence of sepsis in their own settings. ⋯ For example, ED physicians in many systems no longer place central lines, a key component of care in serious sepsis cases. Screening tools used to identify sepsis in adults have no validity in children, making identification of sepsis in youngsters particularly difficult.
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Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. ⋯ Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis.
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Emergency department administrators at Cambridge Health Alliance, a three-hospital health care organization in Cambridge, MA, implemented a system-wide flow initiative that has reduced the average length-of-stay for rapid assessment patients from three hours to just over an hour. Under the approach, patients are immediately placed in a room, and providers and registration staff come to the patients rather than the traditional approach of having patients constantly move from place to place with wait times in between each interval of care. ⋯ The leave-without-being-seen (LWBS) rate has been slashed from 4.5% to 0.6%. System-wide ED volume, which was dropping before the new approach was implemented, has gone from 77,000 patients per year to nearly 100,000 patients per year.
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Christiana Hospital in Newark, DE, has been able to dramatically reduce length-of-stay in the ED by making use of data derived from a real-time location system (RTLS) that tracks the movements of patients, providers, and staff. Administrators say that while some efficiencies are gained from the system alone, most of the positive impact is derived from using the RTLS data to focus on specific processes and make refinements. ⋯ Similarly, a work group focused on the ESI 3 population reduced the average treatment time for this population from 5 or 6 hours to 3.4 hours. Administrators say key steps toward a successful RTLS implementation are careful planning for how you want to use the technology, and alleviating staff concerns about why their movements are being tracked.