Ambulatory Care Quarterly

Involve clinicians in egress plans

There are any number of reasons why an ED and its hospital would have difficulty complying with The Joint Commission standard regarding egress, says Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles.

"These include space limitations for the volume of patients, an inability to efficiently manage patient flow, and selecting equipment without the input of clinicians or concern for regulatory standards," Contino says.

Involving clinicians who understand the standards in the selection of equipment improves the ability to incorporate equipment that is useful and efficient, she says. "It is the clinicians who understand the impact of three large vital-sign monitors on poles for 12 rooms. All three poles usually end up in the hallway," she notes. "One medication cart with one barcode reader for 12 rooms usually results in a cart remaining in the hallway."

The involvement of clinicians facilitates the selection of the ideal process/procedures and equipment to meet the egress standards, Contino says. "For example, many clinicians have encouraged the use of asset tracking systems," she says. "These systems create real-time visibility of all equipment or tagged assets, allowing staff to put them in storage areas to maintain egress, while enabling rapid location." Other clinicians have conducted Lean projects to document mounting vital sign and computer equipment in the rooms, which saves staff time and reduces loss — justifying the costs of the additional equipment, she says.

"The bottom line is that clinicians should be actively involved in the selection of equipment and processes to maintain egress, as well as the accountability to adhering to the standards," says Contino.

There are other approaches ED leaders can take to help improve egress, adds James Augustine, MD, FACEP, director of clinical operations at Emergency Medicine Physicians, an emergency physician partnership group in Canton, OH. "Many hospitals have come to use new storage systems that allow them to more efficiently store supplies for the ED and have more space available for large pieces of equipment like EKG machines and computers on wheels," he says.

When it comes to the boarding of patients, Augustine says, "Hallway egress is a common cause of problems. That requires us to more effectively predict our volumes and create care spaces so that patient management can occur in a room as opposed to a hallway." Part of that process involves efficient movement of admitted patients to the floors, he says.

Barnes-Jewish Hospital in St. Louis, MO, has created an 18-bed transition unit away from the ED that takes just ED patients waiting for admission, reports Darryl Williams, RN, BSN, clinical manager of the ED. "That has really helped us maintain integrity of egress," Williams says.

When it comes to compliance with all Joint Commission standards, Contino adds this reminder for ED managers: "There are many ways to achieve the standards. The Joint Commission doesn't tell you 'how' to do it, but they define 'what' you need to do."