process improvement project-2
TRANSCRIPT
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.