‘Flow techs’ help ED run smoothly
Flow techs’ help ED run smoothly
Position frees up valuable time for ED physicians
The creation of two new positions in the ED has improved flow and increased patient safety, according to Gregory Smolin, DO, FACOEP, FACEP, medical director of the ED at Memorial Hospital of York (PA) County. The new staff members, called flow technicians — or "flow techs" — handle a wide range of responsibilities including handling discharge instructions, finding charts and results for the doctors, and checking to see that all patients have received the treatment that was ordered.
Since the new staffing model went live in January 2006, he says it is too soon to obtain data to demonstrate improvement, but he says the new arrangement has absolutely saved physicians time and improved efficiency and safety.
Smolin got the idea for the position when he visited Capitol Hill on a lobbying trip with the American College of Emergency Physicians. "For years I had been frustrated by fact that the time I spend on my average shift is probably 85% peripheral to what my skill set is, and every time I have to stop and do something that is distracting, it’s an efficiency issue and a safety issue," he says. Then, Smolin saw the way senators and representatives use their staffs. "Everyone wants a piece of them — just like us," he says. "They have people around them to act as an interface, so they do not have to stop doing what they’re doing."
Smolin established seven objectives for the new position:
- enhance the flow in the ED;
- improve patient care;
- decrease time spent waiting for treatment;
- decrease delays between treatment (i.e., waiting for results);
- decrease patient time spent in the ED;
- decrease stress for the doctors, nurses, techs, X-ray, and so forth;
- facilitate communication between staff.
Flow techs are staffed from 11 a.m. until 11 p.m. seven days a week. When they come in, they touch base right away with the ED physician, explains Marcia Feehan, RN, CEN, the ED manager. "They look at the flow board, usually pull every patient’s chart, and make rounds through charting and diagnostics, literally seeing where all the patients are and where the physician is at that point in the treatment path," Feehan says. "Then, they jump right in and start assisting the physician."
Pilot program valuable
Before launching the initiative, Smolin implemented a pilot program which, while not ideal, was extremely valuable in terms of honing the job description.
"I can’t say the trial was successful," concedes Smolin, noting that there were two ED technicians on staff who had volunteered for the posts. "We did not have a complete job description, and at the time we did not have them as additional staff."
Because of that, the pilot program took them away from their normal jobs, which the nurses resented. "However, it gave the people who were doing it the opportunity to see what they could do for us," Smolin says. The managers sat down with them and the nurses and asked for their input. "There were functions they developed we had never even considered," Smolin says. (For some examples, See box.)
Feehan says, "We focused on the idea of how we could enhance customer service within the department and how the role will really facilitate flow."
Smolin concedes that the position, as first conceived, was close to that of a physician extender. "We spun the position on its head to make it not be a doctor’s assistant, but rather implemented it to be a resource for everyone in the department," he says.
The go-to’ person
Now, Smolin declares, the flow tech is the "go-to" person for the entire department.
"They save nurses time," he says. "In the past, they might have had to wait in line to talk to the physician. Now, they go to the flow tech and tell him the lady in bed four needs something for pain." The flow tech relays the information. "I turn around and [write the prescription] and go back to what I was doing," Smolin says.
All discharge planning is computerized, he says. "I tell the flow tech the kid in bed six is ready go home, he has X’ meds for nausea, call his physician in two days," Smolin says. "They come back with a complete printout ready to be signed." It’s an amazing increase in the ED’s efficiency, he says. "In the past, every time I had to stop to do this, everything else stopped."
From a patient safety standpoint, the flow tech keeps track of labs and X-rays. Also, "if meds have not been given, the flow tech goes and finds the doc," says Smolin.
For Feehan, the greatest benefit has been enhanced communication among the physician, the patient, the family, and staff. "A common question might be, What are we waiting for in bed one?’" she shares. "You can usually take that question to the flow tech, and she will know the answer, That’s huge."
Sources
For more information on flow techs, contact:
- Marcia Feehan, RN, CEN, Manager, Emergency Department, Memorial Hospital of York County, 325 S. Belmont St., York, PA 17405. Phone: (800) 436-4326.
- Gregory Smolin, DO, FACOEP, FACEP, Medical Director, Emergency Department, Memorial Hospital of York County, 325 S. Belmont St., York, PA 17405. Phone: (800) 436-4326. E-mail: [email protected].
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