Abstract
Session G presented Friday, September 28, 1:00-2:00 pm
Purpose: Emergency Departments (EDs) face many challenges. Managing the influx of new patients and overall patient flow in busy EDs is a challenge. Dealing with complex, time consuming medical scenarios, while simultaneously addressing lower acuity issues is critical to providing high quality care. The purpose of this project was to have every patient seen by a provider in under 20 minutes while improving the ED's Left without being seen (LWBS) rate by redesigning flow.
Design: Quality improvement project.
Setting: Teaching, urban 70,000 visit ED. Participants/Subjects: ED RNs, ED Physicians, ED Leadership, ED Unit Staff.
Methods: By combining the collective expertise across departments, mixing in teamwork, and change management skills, a flow redesign was developed to reduce the time to see a physician and improve the efficiency and experience of care delivered to all patients. In October 2016, an ED Physician and Nursing Leadership Summit was held to re-design care delivery based on a consultant's report and recommendations. A charter for the "Fast Forward" project focused on a goal of having every patient seen by a provider within 20 minutes within 3 months. To accomplish that goal, a change package based on data was designed using existing staffing and space. Key project elements included: 1. Develop new split stream triage model; 2. Team triage--move provider to Triage while continuing vertical model with Certified Nursing Assistants to front-end the work-up; 3. Create Nursing Flow Coordinator role; 4. Establish fast track area; and 5. Develop a "Turn in Ten" program with housekeeping to turn over ED beds in 10 minutes. This plan was vetted and modified with staff input and four rapid cycle trials of the new model were completed. Go live began on January 3, 2017.
Results/Outcomes: A successfully re-designed process showed that this a new model of care reduced the time to see a physician and number of patients that LWBS . Comparing baseline with first 6 months post go live, demonstrated a reduced LWBS 2.9% down to 1.7% and shorter door to doctor time 41 minutes down to 24 minutes despite a significant increase in volume. The ED continues to struggle when boarding of inpatients reduces the ED's capacity to significantly improve length of stay (LOS). Overall LOS for all patients has only moved from 264 minutes to 257 minutes. The most significant LOS change was for the lower acuity patients which improved from 236 minutes to 130 minutes. Patient experience in both overall rating of ER care and likelihood of recommending, show trends in a positive direction.
Implications: Left without being seen (LWBS) numbers are now tracked by Centers for Medicare and Medicaid Services and publicly reported. Improving these outcomes is an important goal for the reputation of each emergency department. As ED volumes increase, it's important to be willing to innovate and seek solutions that will reduce the time to see a physician and improve the efficiency and experience of care delivered to all patients.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Patient Flow, Re-engineering ED, Emergency Departments
Recommended Citation
Brennan, Denise; Bubly, Gary; Jenouri, Ilse; Boss, Robert III; Robin, Nancy M.; Amore, Christopher; D'Elena, Tara; and Corbett, James, "Fast forward to a future state: Reengineering emergency department flow" (2019). General Submissions: Presenations (Oral and Poster). 145.
https://www.sigmarepository.org/gen_sub_presentations/2018/posters/145
Conference Name
Emergency Nursing 2018
Conference Host
Emergency Nurses Association
Conference Location
Pittsburgh, Pennsylvania, USA
Conference Year
2018
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Fast forward to a future state: Reengineering emergency department flow
Pittsburgh, Pennsylvania, USA
Session G presented Friday, September 28, 1:00-2:00 pm
Purpose: Emergency Departments (EDs) face many challenges. Managing the influx of new patients and overall patient flow in busy EDs is a challenge. Dealing with complex, time consuming medical scenarios, while simultaneously addressing lower acuity issues is critical to providing high quality care. The purpose of this project was to have every patient seen by a provider in under 20 minutes while improving the ED's Left without being seen (LWBS) rate by redesigning flow.
Design: Quality improvement project.
Setting: Teaching, urban 70,000 visit ED. Participants/Subjects: ED RNs, ED Physicians, ED Leadership, ED Unit Staff.
Methods: By combining the collective expertise across departments, mixing in teamwork, and change management skills, a flow redesign was developed to reduce the time to see a physician and improve the efficiency and experience of care delivered to all patients. In October 2016, an ED Physician and Nursing Leadership Summit was held to re-design care delivery based on a consultant's report and recommendations. A charter for the "Fast Forward" project focused on a goal of having every patient seen by a provider within 20 minutes within 3 months. To accomplish that goal, a change package based on data was designed using existing staffing and space. Key project elements included: 1. Develop new split stream triage model; 2. Team triage--move provider to Triage while continuing vertical model with Certified Nursing Assistants to front-end the work-up; 3. Create Nursing Flow Coordinator role; 4. Establish fast track area; and 5. Develop a "Turn in Ten" program with housekeeping to turn over ED beds in 10 minutes. This plan was vetted and modified with staff input and four rapid cycle trials of the new model were completed. Go live began on January 3, 2017.
Results/Outcomes: A successfully re-designed process showed that this a new model of care reduced the time to see a physician and number of patients that LWBS . Comparing baseline with first 6 months post go live, demonstrated a reduced LWBS 2.9% down to 1.7% and shorter door to doctor time 41 minutes down to 24 minutes despite a significant increase in volume. The ED continues to struggle when boarding of inpatients reduces the ED's capacity to significantly improve length of stay (LOS). Overall LOS for all patients has only moved from 264 minutes to 257 minutes. The most significant LOS change was for the lower acuity patients which improved from 236 minutes to 130 minutes. Patient experience in both overall rating of ER care and likelihood of recommending, show trends in a positive direction.
Implications: Left without being seen (LWBS) numbers are now tracked by Centers for Medicare and Medicaid Services and publicly reported. Improving these outcomes is an important goal for the reputation of each emergency department. As ED volumes increase, it's important to be willing to innovate and seek solutions that will reduce the time to see a physician and improve the efficiency and experience of care delivered to all patients.