Abstract
Purpose: The purpose of this interactive session is to examine current trends, processes, and research pertinent to increasing timely and accurate placement and transition of acutely ill patients from the Emergency Department to inpatient units. This performance improvement project aimed to increase timely and correct placement of patients admitted from Emergency Department (ED) to Cardiac Progressive Care (CPC) unit. Design: The following performance improvement project aimed to increase timely and correct patient placement admitted from the ED to the Cardiac Progressive Care unit, using the LEAN approach. A rapid improvement event took place in May, 2014. The study included a quantitative and qualitative component. Baseline metrics reflected (a) wait times for transfer from ED to CPC averaged 120 minutes; (b) one-third of admissions to CPC were incorrectly placed, resulting in subsequent transfers; and (c) patient scores on likelihood of recommending the hospital averaged 66% for CPC. Setting: This project took place in a 400 bed teaching hospital with a volume of approximately 60,000 ED visits annually. The hospital is a Level III Trauma Center, Stroke Center of Excellence and Chest Pain Center of Excellence. Participants/Subjects: All ED staff and Cardiac Progressive Care staff participated in this project. Methods: An RIE team formed to analyze baseline data and test new processes with measureable outcomes. Emergency admission processes were examined in a LEAN rapid improvement event in early 2014. New processes based on Healthy Work Environment standards simplified bed placement decisions, streamlined communication on bed-readiness, eliminated verbal report during handoff, timed communication between units, and provided in-person assistance to move patients. CPC adopted three new processes to efficiently "pull" patients from ED, including (a) CPC RNs review electronic information rather than receive verbal report on new admissions; (b) CPC RN “buddy†system streamlines admission tasks; and (c) CPC staff contact ED every 15 minutes until patients arrive and, when necessary, go to ED and bring patients to CPC. Results/Outcomes: In 12 weeks, correct CPC placement of ED patients increased from 69% to 94%; average time waiting for transfer decreased from 120 to 47 minutes; and patients’ likelihood of recommending the hospital increased by 7%. Informal feedback reflected increased collaboration between ED and CPC staff and increased CPC staff satisfaction with the new report process, fewer avoidable transfers, fewer influxes of admissions at change-of-shift, and less cleaning after avoidable transfers. Implications: This project improved efficiency and accuracy of emergency admissions to CPC. This project created a model for use in other unit-to-unit transitions of acutely ill patients. This process has continued to yield impressive decrease in wait times, increased patient satisfaction and increased staff satisfaction over the past three years. This process has recently been spread to the other inpatient units throughout the hospital. Since implementing this process hospital wide, the Left Without Being Seen rate has decreased from an average of 3.75 to an average of 1.9 for the 2017 year.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Throughput, Left Without Being Seen (LWBS), ED to Inpatient Ward Transition
Recommended Citation
Lambert, Dallas; Anderson, Kate; and Simons, Ivy, "From ER to inpatient: Right processes, right placement, right timing" (2019). General Submissions: Presenations (Oral and Poster). 153.
https://www.sigmarepository.org/gen_sub_presentations/2018/posters/153
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
From ER to inpatient: Right processes, right placement, right timing
Pittsburgh, Pennsylvania, USA
Purpose: The purpose of this interactive session is to examine current trends, processes, and research pertinent to increasing timely and accurate placement and transition of acutely ill patients from the Emergency Department to inpatient units. This performance improvement project aimed to increase timely and correct placement of patients admitted from Emergency Department (ED) to Cardiac Progressive Care (CPC) unit. Design: The following performance improvement project aimed to increase timely and correct patient placement admitted from the ED to the Cardiac Progressive Care unit, using the LEAN approach. A rapid improvement event took place in May, 2014. The study included a quantitative and qualitative component. Baseline metrics reflected (a) wait times for transfer from ED to CPC averaged 120 minutes; (b) one-third of admissions to CPC were incorrectly placed, resulting in subsequent transfers; and (c) patient scores on likelihood of recommending the hospital averaged 66% for CPC. Setting: This project took place in a 400 bed teaching hospital with a volume of approximately 60,000 ED visits annually. The hospital is a Level III Trauma Center, Stroke Center of Excellence and Chest Pain Center of Excellence. Participants/Subjects: All ED staff and Cardiac Progressive Care staff participated in this project. Methods: An RIE team formed to analyze baseline data and test new processes with measureable outcomes. Emergency admission processes were examined in a LEAN rapid improvement event in early 2014. New processes based on Healthy Work Environment standards simplified bed placement decisions, streamlined communication on bed-readiness, eliminated verbal report during handoff, timed communication between units, and provided in-person assistance to move patients. CPC adopted three new processes to efficiently "pull" patients from ED, including (a) CPC RNs review electronic information rather than receive verbal report on new admissions; (b) CPC RN “buddy†system streamlines admission tasks; and (c) CPC staff contact ED every 15 minutes until patients arrive and, when necessary, go to ED and bring patients to CPC. Results/Outcomes: In 12 weeks, correct CPC placement of ED patients increased from 69% to 94%; average time waiting for transfer decreased from 120 to 47 minutes; and patients’ likelihood of recommending the hospital increased by 7%. Informal feedback reflected increased collaboration between ED and CPC staff and increased CPC staff satisfaction with the new report process, fewer avoidable transfers, fewer influxes of admissions at change-of-shift, and less cleaning after avoidable transfers. Implications: This project improved efficiency and accuracy of emergency admissions to CPC. This project created a model for use in other unit-to-unit transitions of acutely ill patients. This process has continued to yield impressive decrease in wait times, increased patient satisfaction and increased staff satisfaction over the past three years. This process has recently been spread to the other inpatient units throughout the hospital. Since implementing this process hospital wide, the Left Without Being Seen rate has decreased from an average of 3.75 to an average of 1.9 for the 2017 year.