Fast forward to a future state: Reengineering emergency department flow
Denise Brennan, MSN, RN, CNL; Gary Bubly, MD, FACEP; Ilse Jenouri, MD, MBA, FACEP; Robert Boss III, BSN, RN, CEN; Nancy Robin, M.ED, RN_BC, CEN; Christopher Amore, BSN, RN; Tara D'Elena, BSN, RN, CEN; James Corbett, AD, BS, RN
- Sigma Affiliation
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Top Visiting Cities
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Brennan, Denise by View
Popular Works for Brennan, Denise by Download
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.
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
|Review Type||Abstract Review Only: Reviewed by Event Host|
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Showing items related by title, author, creator and subjects.
Robin, Nancy M.; Brennan, Denise; Boss, Robert III; Amore, Christopher; D'Elena, Tara; Corbett, JamesSession D presented Thursday, September 27, 2:30-3:30 pm Purpose: Active shooter events have been on the increase in public areas including hospitals, schools and churches. Many hospitals have developed plans to address ...
Brennan, Denise; Robin, Nancy M.; Boss, Robert III; Amore, Christopher; Corbett, James; Kane, Joanne (2017-12-04)Session G presented Saturday, September 16, 2017 Purpose: The Emergency Department (ED)reviewed specific aggregate and unit survey questions based on our National Database of Nursing Quality Indicators (NDNQI) nurse ...
Brennan, Denise; Robin, Nancy M.; Boss, Robert III; Kane, Joanne; Amore, Christopher; Corbett, James (2017-12-04)Session I presented Saturday, September 16, 2017 Purpose: Stroke Centers work on quality initiatives to improve the care stroke patients receive. In August 2015, door to computerized tomography (CT) scan time was ...
The Re-Engineered Discharge (RED) toolkit for patients with heart failure and impact on 30-day readmission rates: An integrative review Mallari, Mary Grace D.; Wechter, Susan M.The RED Toolkit has been found to reduce 30-day readmission rates, improve patient experience, and lower healthcare costs. Nurse-led quality improvement initiatives like the Project RED aligns with the promotion of ...
The use of the Re-Engineered Discharge (RED) Toolkit on patients undergoing a hip or knee joint replacement or revision Mitchell, Kathleen; Chen, Huey-ShysDischarge planning plays a crucial role in the transition of care. Despite the expenditures dedicated towards discharge planning, organizations struggle with reducing 30-day readmission rates, improving patient satisfaction ...