Here’s what you need to measure
Here’s what you need to measure
Want to reduce your diversion rates? You’ll need to select indicators in order to track your progress, says Mary M. MacLeod, RN, BSN, MBA, director of emergency services and pre-hospital care for Hamilton Health Sciences Corp., a four-facility hospital system in Ontario, Canada. She suggests tracking the following:
- redirect or bypass rates for ambulances by day of week and time of day in eight-hour increments;
- admitted patient numbers by day of week and by department;
- calculation of lost revenue days on insurance of a patient not being in a inpatient bed;
- diagnostic delays;
- the time from the admissions order is written until the patient gets an inpatient bed by department;
- canceled surgeries due to no beds;
- cancellation rate for scheduled care of any kind;
- length of time from patient being "admitted" until the time they reach their inpatient bed;
- ED redirect and critical care bypass rates;
- length of stay for key diagnostic groups;
- telemetry or monitor rates and outcomes;
- consultant/specialist response time to ED after a referral is made;
- elective patient transfer wait times;
- isolation case rates;
- patient satisfaction.
A two-week "snapshot" of these data is all you need, says MacLeod. "Keep it simple," she advises. Once data are collected on the various chosen indicators, the next step is to prioritize your needs and determine how changes will be handled, says MacLeod. "For instance, if you have high infection and therefore high isolation rates, and you have to close beds to keep the infection contained, then you’ll need to tackle this issue," she explains. MacLeod offers solutions for this scenario:
- Close all extra beds and move the staff to another area.
- Open a closed area and move staff to that area to keep the bed numbers the same.
- If there is one patient needing isolation in a four-bed room, move the patient to a private room instead of closing the remaining three beds.
- Make sure that staff practice frequent hand washing. "This is key to keeping the area open and functioning even with isolation needs," MacLeod says.
- Obtain input from infection control nurses about patient needs and how beds can be used on the area. "Areas are often quick to close, but take a long time to reopen," says MacLeod.
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