Time Matters! Improve Satisfaction, Decrease LWBS, and Enhance Throughput

Abstract

Session E presented Friday, September 28, 10:00-11:00 am Purpose: Improving patient satisfaction, decreasing left without being seen rates, and improving ED throughput were the objectives for embarking on this journey to streamline treatment of ESI 4 and 5 patients. Design: This quality assurance project was implemented by the ED Throughput Team based on current evidence. Setting: A private, not-for-profit Community Hospital located in the urban southeastern part of the United States. This EBP project was conducted in a 58 bed ED that provides care for approximately 70,000 patients per year. Participants/Subjects: All patients assigned an ESI level 4 or 5 were included and all ED staff members contributed to and followed the updated processes for care delivery. Methods: The current process for managing ESI 4 and 5 patients was mapped by the ED Throughput team. Gaps were identified in flow and improvements implemented including First Nurse assessment and triage bypass, relocation of ESI 4 and 5 waiting area, negotiation of patient placement between Charge RN and Providers, and utilization of consistent staff in designated area. Process changes were reviewed at staff meetings, through written education, and through direct observation of performance with remediation for missed opportunities. Results/Outcomes: During the 12-month implementation of this project, door-to-discharge times for ESI 4 and 5 patients was reduced by 16 minutes, from 128.23 minutes to 112.7 minutes. Patient satisfaction was improved from a mean score of 83.9 to 85.6. LWBS rates decreased from 3.0% to 2.0%. Implications: By improving flow for the ESI 4 and 5 patients, we were able to reduce our door-to-discharge times, decrease our wait times and decrease LWBS rates. Relocating the waiting area from the main lobby to a separate space improved patient perception and impacted a rise in mean patient satisfaction scores. Utilizing the First Nurse to rapidly assess patients and sort them to the correct treatment area was critical to the success of this project. Staff education and buy-in to making incremental changes in processes made this project sustainable.