System says ED patients will have zero wait times
System says ED patients will have zero wait times
Cooperation from multiple departments successful
Not content with a 30-minute guarantee that it has been offering its ED patients for six years, Michigan's Oakwood Healthcare System has declared that patients will now be seen as soon as they walk though the ED doors. So far, so good, say ED staffers, who concede that the new approach could not have been accomplished by the ED alone.
"A lot of the processes implemented with our 30-minute guarantee were working and continue to work," says Tracy Case, RN, BSN, clinical nurse manager of the 62-bed ED at Oakwood Hospital and Medical Center, Dearborn (one of the system's five EDs). Case was involved in the original implementation of the 30-minute guarantee. "A lot of what initially happened was structured in the ED, but we all had to focus on this together to make [the zero wait time] work," Case says. The ED is very much affected by the rest of the hospital "because we need throughput to get patients admitted up to the floor," she says.
The impetus for the new policy came directly from the ED's patients, explains Lori Stallings, RN, BSN, director of emergency services. "As a system, we have spoken to our customers since the implementation of the 30-minute guarantee," Stallings says. They have had multiple surveys and telephone conferences conducted by the marketing department, she says. "More than a guarantee [of a short wait], they were looking to get to a physician and have their care started immediately," Stallings says.
This reduction in wait time required a "Herculean" effort on the part of a multidisciplined process improvement team, formed in 2005. That team consisted of about 800 people, including a central corporate division and smaller teams involving every manager and medical director. Participating departments included everything from transportation to administration. For example, the radiology department went to a 10-minute turnaround on transcriptions (printing, reading exams.) "That's down from what could have been up to an hour," notes Stallings. "The labs also improved their robotic system to help decrease patient length of stay."
More monitored beds were added to the hospital; thus, in the ED there usually is a bed ready for patients in less than 30 minutes.
To accommodate patients who needed but could not get a monitored bed, the observation area was expanded and a transitional unit was created on the fifth floor that was directed and managed by Stallings. "This allows those patients to move out of the ED," she explains. "They are still in a hospital bed, cared for by an attending physician, but they are not in the ED on a stretcher."
In the past, a cath lab patient who may have been able to be discharged in the morning might have still occupied a telemetry bed in the monitored unit. Now, that bed can be freed for a patient who needs monitoring in the unit.
How it works
The new system works like this: When walk-in patients arrive in the ED, the first person they see and are greeted by is an RN, who is always stationed within five feet of the door. Their complaint is taken, and they are registered immediately by someone from the registration staff. "Then they are taken directly to a triage room where, depending on the complaint, care is started immediately," says Stallings.
There is a set of specific guidelines created by the performance improvement teams and signed off on by the medical director that cover care the nurses can provide if the patient cannot see a physician right away, says Stallings. "These include extremity X-rays, urine tests, lab work — different things that may facilitate throughput," she explains. "They are utilized frequently, to ensure the patient is actually getting care started even if they are not getting to a physician immediately." ( See example of the guidelines for chest pain)
All of the ED staff has been trained on the new policy and procedures. "We don't start anything here unless 85% of the staff has been inserviced," says Stallings.
Since the new policy has been implemented, there has been an increase in patient volume and in admissions, with the inpatient side of the hospital responding effectively in getting the patients in-house, Stalling reports. "Press-Ganey [patient satisfaction] scores have risen systemwide, patients are much happier, and our exit surveys have been very positive," she says, adding that one of the smaller EDs in the system said they recently received an 85% Press Ganey score on "likelihood to recommend." "Ours here are not quite that high, but they have almost doubled from what they were just a couple of months ago," she adds.
Stallings insists that EDs of any size could do what Oakwood has done. "One of our EDs has nine beds, and we have 62," she points out. "What you need is the support of the administration and the undivided support of the inpatient side as well."
Sources
- Tracy Case, RN, BSN Clinical Nurse Manager, Lori Stallings, RN, BSN, Director of Emergency Services, Oakwood Hospital and Medical Center, 18101 Oakwood Blvd., Dearborn, MI 48123. Phone: (313) 593-8435.
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