Optimizing ED Throughput
View File(s)
PDF (157.5Kb)
Author Information
- Author(s)
- Details
-
Puneet G. Freibott, RN, CCRN (Alumnus), NE-BC
- Sigma Affiliation
- Zeta Pi
Visitor Statistics
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Country | Visits |
---|
Top Visiting Cities
City | Visits |
---|
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Freibott, Puneet G. by View
Title | Page Views |
---|
Popular Works for Freibott, Puneet G. by Download
Title | Downloads |
---|
View Citations
Citations
The citations below are meant to be used as guidelines. Patrons must make any necessary corrections before using. Pay special attention to personal names, capitalization, and dates. Always consult appropriate citation style resources for the exact formatting and punctuation guidelines.
Item Information
Item Link - Use this link for citations and online mentions.
Abstract
Session presented on Monday, November 9, 2015 and Tuesday, November 10, 2015: Emergency Departments (EDs) play a pivotal role in the delivery of emergent and urgent ambulatory patient care. EDs bridge the gap in care presented by the current healthcare system related to a decrease in primary care physicians and clinic appointments and higher rate of uninsured or underinsured patients (Schuur & Venkatesh, 2012). Stauber (2013) reported closure of 425 hospital based EDs nationwide, which is inversely proportionate to an 18.9 million increase in ED visits in the years 1996 to 2006, alongside a decrease in 198,000 inpatients beds. This increased input and decreased output poses a stagnation of patients being able to move out of the ED, leaving a majority of the EDs struggling with overcapacity. With more patients utilizing ED for their primary care needs, moving patients through complex levels of services can be challenging. Baylor St. Luke's Medical Center (BSLMC) struggles with its bed flow capacity and management in the ED. In 2006, the Institute of Medicine (IOM) published a report on the future of emergency care. Some of the challenges listed included, demand outpacing capacity, ED crowding, boarding, ambulance diversion, uncompensated care, inefficient use of resources, inadequate surge capacity, inadequate protection for staff, inadequate supply of on-call specialists, medical liability, fragmented systems, lack of performance measurement and accountability, and inadequate research funding and infrastructure (Bernstein et al., 2009; Institute of Medicine, 2006). These barriers had severe consequences on the clinical, quality, financial, and service outcomes on the patients and the institutions. The clinical and quality impact included delay in the provision of care and patients leaving the ED without receiving care. Decreased admissions from the ED and lost revenue associated with diversions and patients leaving the institutions without receiving care were some of the financial burdens associated with ineffective ED throughput. Service impact included low patient satisfaction scores and decreased utilization of other hospital services. The Centers for Medicare and Medicaid Services (CMS) announced ED- related measures for Hospital Value-Based Purchasing (HVBP) in 2010. The measures were (1) Median time from door to diagnostic evaluation by a qualified professional; (2) Median time from ED arrival to ED departure for patients subsequently admitted to an inpatient setting; (3) Median time from disposition decision to admit to the time of transfer to an inpatient care setting; and (4) Median time from arrival to ED departure for patients discharged from the ED. CMS's reimbursement based on the ED-related measures were effective starting 2014. Two percent reductions on reimbursement were at stake if metrics were not met. At the commencement of the PIP, CHI Baylor St. Luke's Medical Center's (BSLMC) ED was faced with inefficient throughput process that placed the patients at safety risk, and the institution at risk for quality of care and financial loss. The metrics with the most opportunities to improve were (1) Median time from door to diagnostic evaluation by a qualified professional was 38 minutes as compared to 14 minutes (National Performance); (2) Median time from ED arrival to ED departure for admitted patients was 339 minutes as compared to 277 minutes (National Performance). (3) BSLMCs ED diversion rate for the six months prior to the PIP implementation were 15% (No national benchmark). (4) Monthly average of patients that left the ED without being seen was six patients (No national benchmark). One of the organization's goals was to improve efficiency, and surpass internal and external metrics without incurring additional costs. The goal of the PIP was to improve the ED throughput times, diversion rates, and the number of patients who leave without being seen by utilizing Rodger's change management theory, and IOWA model's framework and stay budget neutral. The relevant stakeholders formed a team and settled on these evidence based focused points, (1) Provide an evaluation area for the ED physicians to evaluate patients in the waiting room when needed, (2) Engage the ED physicians to promote the shift in culture of evaluating and treating patients in the waiting room when needed, (3) Utilize evidence based standing delegation orders in the waiting room to initiate evaluation of patient's chief complaint, (4) Provide training for ED charge nurses to fulfill the role of patient flow coordinators in the waiting room, promoting communication and safety, (5) Engage the ancillary departments of laboratory and radiology to provide better efficiencies for patients in the ED by reducing the turnaround times on tests and procedures. Training, education, and communication were disseminated and the project initiated its six months pilot on August 1, 2013. The project was successful in statistically decreasing the time intervals for (1) Median time from door to diagnostic evaluation by a qualified professional, p < 0.001; (2) BSLMCs ED diversion rate p < 0.005 (3) Patients that left the ED without being seen, p < 0.001; (4) Radiology and laboratory turnaround times, both at p < 0.001 levels. The project remained budget neutral, by not adding any additional resources or costs to the organization. The project failed to decrease the median time from ED arrival to ED departure for admitted patients, p > 0.05. Strategies that were successful included, interdisciplinary collaboration towards a common vision, formative evaluation for barriers presented during the course of the PIP, engagement and buy-in from all stakeholders, and an organizational goal to improve the stated benchmarks. Some of the barriers presented during the course of the PIP were, organizational change of St. Luke's Episcopal Hospital System being bought out by Catholic Health Initiatives and Baylor Institute of Medicine, and its impact on the organization and, unseasonal influx of influenza patients and its encumbrances on hospital resources, patient volume, and length of stay in the hospital presenting a bottle neck for the ED patients awaiting inpatient beds. Evaluation of this PIP lures the idea to dive deeper into the impact of ancillary department's productivity and efficiencies to the ED throughput. There were different models of care, such an ED based laboratory that was not contemplated during this PIP. The effects of housekeeping and staffing of all services, was not pursued during this project and could play a part in ED throughput. The PIP utilized the metrics as required by the CMS; it would have been beneficial to review all patients' charts to fully understand the impact of each patient's scenario and the barriers and facilitators of ED throughput at the organization. The PIP has managed to change the physician and nursing culture at the BSLMC ED, but needs constant vigilance and prioritization by ancillary and inpatient departments to promote ED throughput. The problem of ED crowding continues throughout the nation and needs translation of evidence based solutions into practice, and policy changes to increase access to care in the U.S.
Description
43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.`
Repository Posting Date
2016-03-21T16:38:39Z
Notes
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository, unless otherwise noted.
Type Information
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Category Information
Evidence Level | |
Keywords | ED Throughput; Multidisciplinary Approach; Improved Core Measures |
Conference Information
Name | 43rd Biennial Convention |
Host | Sigma Theta Tau International |
Location | Las Vegas, Nevada, USA |
Date | 2015 |
Rights Holder
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.
Related items
Showing items related by title, author, creator and subjects.
-
A multipronged approach to improving ED throughput
Stanfield, Laura; Johnson, Tiffany; Moyer, Greg; Hunt, Debbie (2017-04-13)Purpose: Improve ED Throughput by incorporating all members of the care team Method: Monthly ED Taskforce meetings to review metrics and develop innovative strategies for improvement Results/Outcomes: Decreased Overall ... -
Optimizing Usability of Electronic Medical Records to Meet and Measure Quality Initiatives
Shultz, Sarah E.; Hand, Mikel W. (9/3/2015)Purpose: The purpose of this evidence based practice project is to improve usability of the Electronic Medical Record (EMR) to demonstrate consistent compliance with venous thromboembolism (VTE) and heart failure (HF) ... -
Optimizing emergency department throughput with improved triage processes
Bimber, Tammy (2014-08-04)Purpose: Triage processes in the emergency department (ED) have a significant impact on patient throughput. Efficient ED throughput is vital to provide safe and high quality patient care and to prevent ED overcrowding. The ... -
How an effective care handoff process can improve ED throughput
Childress, Wendy; Upham, Jason; Rhew, Denise C.Poster presentationSession B presented Monday, September 30,11:30 am-12:30 pmPurpose: Large volumes in the Emergency Department can be overwhelming for staff and dangerous for patients. Factors such as staffing and bed ... -
A multidisciplinary mentoring approach to improve the equity of nursing education for the English language learner in an undergraduate nursing program: A mixed-method quality improvement project
Bisila, LaurieNature and scope of the project: This quality improvement (QI) project is a multidisciplinary approach to mentoring, matching a doctorate of nurse practice (DNP) student in their final year and a second-semester ...