Emergency Department Throughput: Immediate Bedding to Reduce Throughput Times
Serenity Glazer, MSN, RN
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Session B presented Thursday, September 14, 2017
Purpose: The purpose of this project was to decrease front-end throughput times at Houston Methodist St. John Emergency Department (ED) by direct bedding patients until all beds are full.
Design: This was a quality improvement project to ensuring patients are seen by a health care provider in a more timely manner and improve patient satisfaction.
Setting: The Emergency Department (ED) at Houston Methodist St John is a 21 bed community based ED in an acute care Hospital. Our Emergency Department see’s about 20,000 Patients a year.
Participants/Subjects: A taskforce consisting of staff nurses, charge nurses, technicians, formal ED nursing leadership, admission, registration team, and the ED physician team, were pulled together to identify bottlenecks in the ED and brainstorm new processes to remove the bottleneck.
Methods: The interdisciplinary team focused on several areas by reviewing patient satisfaction surveys and comments reporting that wait times in the ED were too long. The team had several problems to find solutions too, unhappy customers, long lengths of stays, and an increase in the number of patients leaving without being seen (LWBS) by a provider. Several team members reviewed the literature to find best practices for triage. Then the taskforce met weekly to construct a new triage process, whereby they outlined exactly what the process was going to be. We measured multiple variables including, door to triage, door to bed, door to provider, patients leaving without being seen, and leaving against medical advice.
Results/Outcomes: Since June we have been in the 90th percentile for Patient Satisfaction with superior results, up from the 50th percentile in the first two quarters of 2016. Our AMA rate for 2016 is currently 2.2% down from 2.4% in 2015 and our greatest result from this project is our left without being seen rate is 0.4% for 2016, down from 2.1% in 2015. From the first quarter of 2016 we saw a 16% reduction in AMA rate and a 94% reduction in our left without being seen rate.
From first quarter to fourth quarter our door to triage have decreased by 85% with median door to triage being 2 minutes for third and fourth quarter, door to bed decreased by 63% with a median of 11 minutes, and our door to provider decreased by 61% with a median time of 6 minutes in 4th quarter.
Implications: This project is remarkable in that not only are our results so convincing, but that our front line inter-disciplinary team created and owned the process. The key to our team’s success is that from the beginning each part of our emergency department team had a voice, and we were able to come together for the safety and betterment of our patients. One of the results that stands out so significantly is how this process decreased our rate of left without being seen to 0.4% for 2016. Lowering this rate means we have become a safer emergency department by ensuring that every patient who checks into our ED is seen by either a midlevel provider or physician.
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