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Improving ED Communication & Patient Throughput

Improving ED Communication & Patient Throughput

Among the many Affordable Care Act initiatives rumbling through the healthcare industry, the introduction of 30 to 40 million new patients is certain to create additional stress to an already overburdened healthcare system. As a result, hospitals must find ways to increase their patient throughput and operational efficiency. Unfortunately, inefficient inpatient discharge practices continue to create unnecessarily long hospital stays. Patient throughput in the ED impacts the rest of the hospital system. ED lengths of stay generally increase when hospital occupancy levels exceed 90%, so enhanced communication and patient throughput are vital throughout the acute care setting. Although many factors can hinder patient flow, nearly 70% of clinicians cite communication as the most challenging cause of patient throughput delays. EDs: The Communication Ground Zero Communication in the ED sets the course for patient flow throughout the hospital. Safe, efficient, quality care in the ED requires frequent and effective communication. Nearly half of EDs report operating at or above capacity, and wait times and patient visits have risen steadily for the last 20 years. Initial communication with ED patients must be a top priority. As soon as patients register at the ED, they must be clearly informed of their anticipated treatment. Early communication about details, such as estimated wait times, anticipated discharge times, and availability of immediate treatments for minor symptoms, can smooth transitions of care.  Intricacies are sometimes forgotten but have a tremendous impact on patient throughput. The physical design of individual patient rooms can greatly affect throughput. When rooms are well-designed and provide optimum flexibility, patients can receive faster, more efficient care. In order to save space for...

A Nationwide Program for Improving Quality & Safety

Throughout the United States, efforts are being made to improve the overall quality of healthcare, reduce racial and ethnic disparities, and provide models for national reform. One such effort is the Aligning Forces for Quality (AF4Q) program. Supported by the Robert Wood Johnson Foundation, the AF4Q program brought together hospitals in 16 geographically, demographically, and economically diverse communities that together cover 12.5% of the U.S. population. Ranging from major metropolitan areas to a Northern California county of 260,000 people, each community partaking in the program makes concerted efforts to address public reporting of quality, patient engagement in care decisions, and physician payment. Each of the 16 communities participated in the AF4Q Hospital Quality Network (HQN). Teams at participating hospitals came together for learning sessions via webinars to identify where problems existed and how they had been addressed. According to Robert Graham, MD, two of the areas focused on for the HQN program were reducing readmissions and improving language services. Catherine A. West, MS, RN, adds that process and outcomes measures were collected and reported monthly to the AF4Q National Program Office at George Washington University. Reducing Hospital Readmissions “The AF4Q program focused strongly on readmissions among patients with congestive heart failure because of their high risk for being readmitted,” says Dr. Graham. “Across the board, participating hospitals achieved the most success with early identification of these patients and participation in transitions programs [Table 1]. These programs allow for patients to know—as they’re discharged—exactly what they need to do, what has changed, why it’s changed, and how to link with physicians in the community. The key is to ensure that...

Addressing ED Crowding With Patient Flow Strategies

The number of ED visits has grown by 25% in the past decade, but the number of hospital EDs and inpatient beds has declined during that same time-frame, resulting in crowded conditions nationwide. Nearly half of EDs are operating at or above capacity, and few consistently achieve recommended wait times for all ED patients. The impact of ED crowding has been profound, leading to poor quality care, increased mortality rates, and lower patient and staff satisfaction. Major Findings on Improving Patient Flow In an effort to strengthen the evidence base for patient flow improvement strategies, Megan C. McHugh, PhD, and colleagues evaluated the efforts of five hospitals that participated in a collaborative aimed at improving patient flow and reducing ED crowding. Results were published in the September 13, 2011 Journal for Healthcare Quality. Participating hospitals implemented seven improvement strategies over 18 months as part of the collaborative. By the end of the study, four of the five hospitals had at least one fully implemented improvement strategy and had experienced modest improvements in patient flow, including reduced length of stay and fewer patients left without being seen. The improvement strategies and their impact varied considerably in the study, according to Dr. McHugh. “Several factors appeared to influence the impact of strategies, including ability to overcome implementation challenges, the timing of implementation, and the type of strategy selected. We also found that the staff time and expenses involved in the adoption of the ED strategies were highly variable.” Few studies have considered time and expenses associated with implementing patient flow strategies. In Dr. McHugh’s study, time spent planning and implementing the...

Expeditors in EDs: Facilitating Patient Throughput

Patients commonly experience lulls in their treatment during the course of their visits to the emergency department (ED). Following the triage of patients, they often wait to be brought back to a room. After initial assessments, they may also need to wait during the diagnostic testing and treatment phases. Wait times can also increase as physicians review patient information and make discharge or admission decisions. During these lulls, emergency physicians may be distracted by the urgent needs of other patients and delays can occur. Expeditors: The Maître d’ of the ED A smoother, more efficient operations model in the ED may help anticipate delays in care. For example, a maître d’ controls the flow of patrons in restaurants, ensuring that guests who arrive are seated quickly, their needs are met, and the table is turned over efficiently for the next customers. With this model in mind, we created a new position at Oregon Health & Science University (OHSU) called an “expeditor” who acted like a maître d’ at a restaurant. The expeditor’s primary responsibility was to ensure patient care moved forward. Other responsibilities included: Communicating with and reassessing patients in the waiting room. Rooming patients as directed by the charge nurse. Assisting with ambulance arrivals. Ensuring pain was controlled and providing analgesics as directed. Placing IVs, drawing labs, and running point-of- care tests. Assisting with the discharge processes (eg, removing IVs and helping patients get dressed). Facilitating patient transport to inpatient units. In the May 2011 Western Journal of Emergency Medicine, my colleagues and I had a study published in which we analyzed the effect of using an expeditor...
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