A split-flow model for ED level 3 patients
Brooke Cabello, BSN, RN; Berta Ruscio, RN; Ami Patel, RN; Tony Woodard, MSN, RN, CNS, ACNS-BC, CEN, CMTE, LP; Phyllis Tipton, PhD, 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 Cabello, Brooke by View
Popular Works for Cabello, Brooke by Download
Purpose: Prolonged wait times and length of stays have inundated Emergency Departments(ED) across the nation. Our ED has struggled with these same hurdles over the past few years. Specifically, patients that are assigned emergency severity index (ESI) level 3 have overwhelmed our department by increasing wait times and length of stays (LOS). Therefore, the purpose of this project was to implement a method to decrease the level 3 emergency department discharged patients’ LOS. A secondary purpose was to reduce our left without being seen (LWBS) level 3 patients.
Design: This is a quality improvement project that was conducted over a two month period beginning in October and carried through November 2016.
Setting: The project took place at our level one trauma ED located in a academic teaching facility in Central Texas. Our ED is a 44 bed unit.
Participants/Subjects: Between October and November our total number of patients seen was 9709 of which 4781 were level 3 patients. Inclusion criteria was ESI level 3 patients that could be evaluated in a fast track area requiring three of more interventions such as: labs, imaging, or medications. Our exclusion criteria was level 3 patients with multiple comorbidities requiring a more complex evaluation in an ED room and likely requiring hospital admission.
Methods: A designated nurse and physician was assigned to run a level 3 focused fast track (FFT) in conjunction with the existing fast track that was managed by advanced practice providers. Physicians reviewed triage notes and vital signs to decide whether the patient met criteria for our focused fast track. Patients were then escorted to FFT room where standing orders/interventions were performed and a focused assessment by physician and nurse completed. FFT patients taken to pending results area to await completed results. Patient was than either discharged or placed in an ED room for further evaluation.
Results/Outcomes: Our pre-intervention average LOS for level 3 patients was 262 minutes. Upon implementation of our project the average decreased to 161 minutes. In addition, our LWBS decreased and patient satisfaction scores increased. As supported by a 25% reduction in wait times and LOS for level 3 patients.
Implications: Level 3 patients were systemically and efficiently processed which decreased LOS. Additionally, the decreased LOS contributed to increased patient and staff satisfaction due to decreased workload to the department. There is a cost savings related to LWBS ($2,000/patient) patients. The average from January to September was 4.33%. LWBS average for October decreased further to 2.44%. November LWBS decreased to 1.63%.
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri
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.
|Review Type||Abstract Review Only: Reviewed by Event Host|
|Evidence Level||Quality Improvement|
|Keywords||Length of Stay;
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.
Level 2 and level 3 patients in a 5-level triage system: Factors related to acuity assignment and trajectory of the emergency department experience Garbez, Roxanne O.Clinical decision making in the emergency department (ED) can have a significant impact on patient safety and health care outcomes. One type of clinical decision making is the process of emergency department triage. Within ...
Improving length of stay: Transitioning care from the emergency department to a clinical decision unit Pastor, Griselle; Ruiz, Justo Jr.; Cronkhite, Van; Mancuso, Natalie; Villoch, EmiliaSession A presented Thursday, September 27, 10:00-11:00 am Purpose: Emergency Departments (ED) experience overcrowding which can lead to unsafe and poor quality outcomes. Overcrowding in the ED can lead to decreased patient ...
Watson, Brandon; Borkowski, Konrad; Conca-Petit, Jonathan (5/18/2017)Overcrowding in emergency departments (EDs) is a national crisis affecting hospitals. It has led to an association with poor patient outcomes and is a threat to public safety. Fast tracks (FTs) in the ED are one strategy ...
Gonzaga-Reardon, Marites; Altman, Patricia; Valentine, Runay; Serafin, Frederick (2015-02-04)Purpose: The purpose of this process improvement project is to evaluate whether the implementation of “Lean approach” interventions in the triage redesign of an urban academic emergency department improves ...
Brennan, Denise; Bubly, Gary; Jenouri, Ilse; Boss, Robert III; Robin, Nancy M.; Amore, Christopher; D'Elena, Tara; Corbett, JamesSession 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 ...