Improving patient flow in Emergency department

By: Sehrish Khakwani, Atinuke Shobowale, & Matthew Lopez

INTRODUCTION➢ ED - Busiest department➢ Throughput refers to emergency department processes that impact patient

flow.➢ “The annual number of ED visits in the United States was 90.3 million in 1996,

and that number increased to 129.8 million in 2010.”(Murphy, Barth, Carlton, Gleason, Cannon 2014)

➢ Includes triage, staffing, availability of specialty and diagnostic services,

surgical scheduling and information technology resources.

BACKGROUND➢ Increase ED lengths of stay➢ Safe, efficient, quality care in the ED requires frequent and effective

communication.➢ The physical design of individual patient rooms can greatly affect throughput.➢ Emergency department crowding has been identified as a major public health

problem in the United States by the Institute of Medicine.➢ Delays in treatment➢ Long wait times

STATEMENT OF PROBLEMED crowding is associated with:

➢ Poor patient outcomes

➢ Longer wait times

➢ Inefficient use of staff

➢ Decreased patient-centered care

➢ Increase of patient not receiving care/ leave without being seen (LWBS)

➢ Impacting Revenue

PURPOSE

➢ To review and analyse the literature concerning ED patient throughput

➢ To find techniques to improve ED efficiency

SIGNIFICANCE

➢ To provide assessment of the throughput of ED patients to identify the gaps in

the system that lead to overcrowding.

➢ To pinpoint where organization can focus its resources to optimize better

outcome.

➢ To provide other organizations with the information needed to manage

emergency department patient flow.

METHODOLOGY

Google Scholar

Research Pro

Search Words:❏ ED patient flow

❏ Patient boarding

❏ Patient crowding

❏ ED crowding

❏ Lean ED

❏ Fast Track ED

❏ RTT ED

❏ Improving ED patients

CONCLUSIONFast Track

➢ Triage patients according to High Acuity or Low Acuity

○ A-side

○ B-side

➢ Patient satisfaction with:

○ wait times

○ doctor courtesy

○ nurse courtesy

○ staying informed about delays

○ staff caring

○ pain control

○ likelihood to recommend

■ Hwang, Lipman, Kane 2014

Rapid Triage and Treatment (RTT)

➢ RTT Physician and Nurse

○ increase efficiency through improved communication and teamwork

○ Lower acuity patient placed in RTT area

■ Can be seen in:

● hallway chairs

● 3 small exam rooms

➢ Decreased:

○ Wait times

○ LWBS rates

■ Murrell, Offerman, kauffman 2010

CONCLUSION CONT.1st - Safety Culture

➢ “Every member of the organization must develop an equivalent commitment to quality” (Zidel, 2011).

➢ Top Down

○ Supervise and Guide

➢ Bottom Up

○ Implementation

CONCLUSION CONT.2nd- Full look at Problem

➢ Creation of Process Improvement Team

○ 15-20 people

○ Multiple disciplines

➢ Value Stream Mapping

➢ Improvement Meetings

○ Frontline Staff

CONCLUSION CONT.3rd - Slow Implementation

➢ Start small

○ How do you eat an elephant?

➢ PDCA

○ Continuous improvement

➢ Common Goal:

○ Safety

○ Quality

○ High Satisfaction

REFERENCES➢ Adamski, P. (2013). Navigating the challenges of patient flow and boarding in hospitals. The Joint Commission Perspectives, 32(6).

➢ Dickson, E. W., Singh, S., Cheung, D. S., Wyatt, C. C., & Nugent, A. S. (2009). Application of lean manufacturing techniques in the

emergency department. The Journal of Emergency Medicine, 37(2), 177–182. http://doi.org/10.1016/j.jemermed.2007.11.108

➢ Hwang, C., Lipman, G., & Kane, M. (2015). Effect of an emergency department fast track on Press-Ganey patient satisfaction scores. Western Journal

of Emergency Medicine, 16(1), 34–38. http://doi.org/10.5811/westjem.2014.11.21768

➢ Joint Commission. (2013). The ‘Patient Flow Standard’ and the 4-hour recommendation. Joint Commission Perspectives, 33(6), 1–4.

Retrieved from http://www.jointcommission.org/assets/1/18/S1-JCP-06-13.pdf

➢ Murrell, K., Offerman, S., & Kauffman, M. (2010). Applying Lean: Implementation of a Rapid Triage and Treatment System. Western Journal of

Emergency Medicine, XII(2), 184–191.

➢ Zidel, T. G. (2011). Lean done right: Achieve and maintain reform in your healthcare organization. Chicago, IL: Health Administration

Press.