Developing a culture of direct bedding in a freestanding ED

Abstract

<p>Session B presented Thursday, September 27, 11:30 am-12:30 pm Purpose: Emergency Department overcrowding is a serious problem that has a strong correlation with patient satisfaction.Wait times and overcrowding in Emergency departments result in patients leaving without being treated and reflects poor patient satisfaction and increased liability. Directly placing patients in beds and bypassing the triage process decreases the patients&rsquo; perception of &ldquo;wait time,&rdquo; thus increasing patient satisfaction.The Freestanding Emergency Department (FSED) has created a culture where direct bedding has resulted in stellar patient perception results and patients that &ldquo;left without being treated&rdquo; (LWOT) well below national benchmark of 2.0. Therefore, in anticipation of increasing volumes, sustaining our current gains may become a challenge. Design: The project was a quality assurance project. The project aim was for fiscal year 2016/2017 the FSED will maintain and sustain Press Ganey patient perception results above the 90th percentile in all domains. In addition, the FSED will maintain patients LWOT's at or below 0.60%. Setting: The setting is a freestanding 19 bed Emergency department which is part of a Community Hospital System located in a seasonal Florida community. The freestanding ED is six miles from the closest admitting campus and serves all age groups. Participants/Subjects: The participants included all Press Ganey surveys returned for the fiscal year 2016/2017 of discharged patients from the freestanding Emergency Department. All Emergency Department staff and ancillary staff participated in the project. Methods: The method used was PDSA (Plan, do, study, act) and using a test of change. Plan: The goal was to sustain current gains of exceeding benchmark in Press Ganey patient satisfaction scores and low LWOT rate via communication strategies. These strategies will focus on reinforcing the practice of direct bedding and its positive effect on patient satisfaction scores and LWOT rate. Do: Shared scores at huddles, staff meetings and posted in the department. Engaged staff in discussions and provided opportunity for feedback. Study: Ongoing monitoring of patient satisfaction, LWOT rates and compliance in use of direct bedding was done daily via metric reporting. Act: Modified process as indicated by staff feedback, results of data collection and compliance in use of direct bedding. Results/Outcomes: The freestanding ED achieved stellar results. The Press Ganey patient perception scores not only were maintained above the 90th percentile the entire year but have exceeded and were maintained in the 99th percentile. The Freestanding ED continues to achieve above the 90th percentile in all domains. The Freestanding ED has maintained an LWOT rate &lt;0.6% and continues to maintain that level. Implications: In conclusion direct bedding has a positive affect on improving patient satisfaction and LWOT rates in a freestanding ED. Direct bedding achieved a high level of employee satisfaction and a strong team culture. Ongoing vigilance is required to ensure direct bedding becomes a hardwired process in the freestanding culture. Assurance is necessary that all ED staff and ancillary staff understand the process and the goals including any float staff.</p>