Other units can 'rescue' the ED
The decrease in the rate of ED patients leaving before treatment at King's Daughters Medical Center in Ashland, KY, from 5% to 0.5% was not achieved by the ED alone. It took a concerted effort on the part of all of the major departments that interface with the ED.
Hourly throughput assessments in the ED result in the charge nurse assigning a color (green, yellow, orange, or red) indicating the current throughput status. "Based on that level, different actions are taken to elevate the urgency of getting resources to the ED to get it moving," explains Mona Thompson, MBA, RN, CPHQ, CENP, vice president of patient services and chief nursing officer.
A page is sent to the hospital's leadership council twice a day indicating the overall status of the organization and specifically the ED. This page goes to every individual with the title of manager, director, or above.
"When the ED gets to orange or red [indicating that throughput is becoming seriously impaired], we do individual hourly pages until that is resolved," says Thompson. This page includes leaders who are at home, adds Thompson, noting that the previous night, a Code Orange was called at 1 a.m. "The expectation is that the entire leadership team will either come in or call to ensure their department is appropriately responding to meet the needs of the ED," she explains.
Brandi Boggs, RN, MSN, director of emergency services, says, for example, "if we are at orange, on the inpatient side, they will look at their units to see if any patients are ready to go home and discharge them in a timely manner to free up a bed. Housekeeping is notified so they can get the beds cleaned."
Thompson adds, "The lab may put an extra phlebotomist in the ED, or the radiologist may call out another tech, depending on what the needs of the particular patient population are at that time. Pages may even be sent to the laundry to make sure there are adequate linens or to have them bring an extra linen cart."