ED management : the monthly update on emergency department management
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The two EDs of Sacred Heart Medical Center in Oregon have been posting their wait times online for several months now, but the introduction of this service didn't come without a great deal of preparation. For example: ED charge nurses at facilities that already had posted wait times online were contacted to see if there had been any problems. A communitywide education effort was put in place to let potential patients know what was coming.
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With changes in place only about six months, Cincinnati Children's Hospital Medical Center, compared the May-July period door-to-doc times and found they had dropped from 61 minutes in 2008 to 45 minutes in 2009. The ED manager interfaces with the hospital's director of patient flow, and they have initiated new processes inside and outside the department: Nurses have been placed at the ED entrance to take a "quick look" at patients. Handoffs are handled via fax, so ED nurses no longer have to track down their inpatient counterparts for a telephone conversation. Mathematical formulas have been created to predict admissions and discharges.
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LEAN methodology, known for uncovering opportunities to improve by eliminating "wasteful" process steps, has helped the ED at Good Samaritan Hospital in Kearney, NE, make good patient flow numbers even better. The hospital went from a door-to-doc time of 28 minutes and length of stay (LOS) of 103 minutes to a door-to-doc time of 16 minutes and a LOS of 93 minutes. Here are some efficiencies that were implemented: standardized bedside carts and procedure carts that can be pulled into any room as needed; a manual-entry whiteboard with magnetized color-coded symbols to indicate patient status; a new documentation system that standardized the ED charting decreased the time required for documentation.
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The ED at Palisades Medical Center in North Bergen, NJ, has slashed its door-to-doc times down to nine minutes with the implementation of a new rapid evaluation unit model and other improved efficiencies. Here are some of the keys to their success: Triage was moved to the bedside, where specially trained nurses' aides perform point-of-care testing following evaluation by a nurse, a physician's assistant, or a doctor. Discussions with other departments made them aware of how their processes affected ED wait times. A discharge area was created to free up more beds in the ED proper.
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ED managers will have more latitude to deal with H1N1 surges thanks to President Obama's recent declaration of a national emergency. Here are some strategies that will help you keep things running smoothly. ⋯ Arrange for alternate treatment sites off-campus. Design a simplified screening process in the event of a medical screening exam (MSE) waiver.