Reducing Low Acuity Length of Stay a Care Paradigm Transition
Nicholas Wilson, BSN, RN; Michelle Reed, MSN, RN, CEN, NE-BC
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Session E presented Friday, September 15, 2017
Purpose: Emergency Department overcrowding is an epidemic in the United States. Use of services is often utilized by patients that do not require the level of care that we often provide. As a result length of stay in this patient population is sometimes extreme. Additionally, this population often times ties up resources that could be utilized to care for sicker and more acute patients. Creating a que or wait for patients is an unsafe practice and lends to less overall effeicient Emergency Departments.
Design: The study that we performed was a quality assurance project. We identified a group of patients that had lengthy waits which could lend to unsafe practices and developed a care model to expodite the care that these patients recieved.
Setting: 24 bed rural Emergency Department located about 45 minutes from the closest Level One trauma center. We see approx 50,000 patients annually, traditionally have had issues with long length of stays for less acute patients.
Participants/Subjects: All ED staff participated in this project. We did select a committee of teammembers that represented all ED job categories for implementation of our rapid assessment area.
Methods: After evaluation of 2015 data, using this is our baseline for tracking, we developed a plan that was named Direct Care. A team was indentified to design a work flow where low acuity patients could be seen in a timely manner in an already existing area in our Emergency Department. After several months of planning, we designed a care paradigm using LEAN principles of promoting effecieny and reducing waste in movement of staff, patients and equiptment. A carousel design was constructed that used 3 treatment rooms for use of assessment, treatment and discharge. A sub waiting area comprised of 3 chairs was constructed for the non-value added purpose of waiting. Patients are moved from the treatment room to subwaiting area while waiitng for procedures or radiology exams. This allowed more patients to be presented to the provider in a more timely manner. We used data from prior year to identify number of patients seen each day on a historical level, identifying what hours of the day we would need to operate this expodited care area to reduce patient waiting, also know as cueing theory.
Results/Outcomes: In the first half of 2016 our overall length of stay for low acuity patients was around 135 minutes, after the implementation of this care area we saw a decrease in length of stay to about 95 minutes. Not only were we able to successfully decrease overall length of stay in this population but greatly decreased the door to physician times as well which is thought to be highly correlated with quality of care. Have drastically reduced our waits in low acuity to patients to often times having no wait.
Implications: Using the above data in results/outomes, you will see that in current care paridigm we are now able to see 3 patients in the same time that we saw 2 prior year. Improved efficiency, quality, safety and service excellence.
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Length of Stay;
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