Patient flow efficiency techniques in emergency department

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  Patient flow efficiency techniques in emergency department
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  • 2. Definitions of “Quality”  The famous experts in the subject define “quality” in the following ways: “Meeting of customers’ needs” (W. Edwards Deming); “Fitness for use” (J.M. Juran); “Conformance to requirements” (Philip B. Crosby).
  • 3. Definitions of “Quality”  “degree of conformity with accepted principles and practices (standards), the degree of satisfying the patient’s needs, and the degree of attainment of acceptable outcomes, while making appropriate use of resources.” (JCI)
  • 4. Efficiency: It is one of the most important key dimensions of quality. It is the optimum utilization of resources to produce the desired outcomes.
  • 5. Goals of Trying to Maximize Patient Flow Efficiency in the E.D.  Improve patient care  Improve patient satisfaction with care  Lessen stress on E.D. staff  Limit financial costs to hospital  Allow more available staff time for teaching
  • 6. What Does Maximizing Patient Flow in the E.D. Really Mean ?  Limiting as much as possible the time intervals between each sequential event that is necessary for patient care  Maintaining quality, safety, completeness, empathy, and personal attention in patient care
  • 7. Fundamental Principles Behind Improving Patient Flow Efficiency  Anything that delays evaluation by the emergency physician is detrimental  Everyone in the department must be committed to & cooperative with efficiency efforts  Provision of emergent care procedures always takes precedence  Making events simultaneous rather than sequential increases efficiency
  • 8. Remember! Maintaining efficiency and speed are important even when the E.D. is not busy, because this enables the E.D. to better handle a sudden, unexpected influx of patients
  • 9. Nursing Triage : Background Aspects Related to Efficiency  Both CBAHI & JCI standards require that all patients be medically evaluated prior to being asked to register  Triage should take < 3 minutes maximum per patient  Space & seating allowance necessary for multiple simultaneous presenting patients ER.8 There is an effective triage process to prioritize emergency patients. ER.8.1 There is a process to identify patients with urgent or emergent care needs. ER.8.2 Patients with urgent or emergent needs are given priority for assessment and appropriate and timely care. ER.8.3 Re-triage is performed when appropriate (e.g., change of medical condition, long waiting time).
  • 10. What Exactly Constitutes Proper Efficient Nursing Triage ? Immediate "experienced eyeball" assessment of the patient's condition "One line" chief complaint Vital signs : o Pulse o BP o Resp. rate o Temp. Current meds & allergies
  • 11. Patient Disposition Options for the Triage Nurse Take patient immediately back to emergency care area Send patient to E.D. registration Send patient to a "non- emergent" care area Send patient to X-ray or laboratory prior to being sent into E.D. o By preapproved written protocol based on chief complaint
  • 12. Time-Saving Techniques at Registration  If others accompany the patient, have them register the patient while triage and initial E.D. care are started  Automatically obtain patient's recent E.D. chart to accompany current chart
  • 13. Standard Efficiency Criteria for Initial Patient Care  For any potentially unstable patient, nursing should go ahead with O2 (2 L/min.), monitor, IV, blood draw, ECG, pulse oximetry, & early ER Physician notification  X-ray +/- resp. techs may need to be notified & activated, but ER Physician should see patient prior to their actions  ER Physician should be notified of priority of multiple simultaneous patients
  • 14. Patient Evaluation Efficiency Techniques for Physicians For several near-simultaneous patients : oSee 1 or 2 simple cases only requiring exam or single x-ray first, then see a more complex or involved patient, then recheck the x-ray results for the simple cases while awaiting lab, etc. for the complex case oHold data completion till after all these patients are seen
  • 15. Draw & send lab tests early if needed o Pelvic & secondary exams should be done after lab is sent o Hold split urine specimen + extra blood tubes in case secondary tests prove needed Complete entire physical exam prior to ordering X-rays so all films can be done at once Patient Evaluation Efficiency Techniques for Physicians
  • 16. Patient Evaluation Efficiency Techniques for Physicians  Lengthy non-resuscitative procedures on patients who are definitely going to be admitted anyway should not delay evaluation & disposition of patients with simple or more minor problems  Verify specific times that labs were sent to know when to check up on them  Once a stable case is turned over to a consultant, don't hover over the patient
  • 17. Suturing Efficiency Techniques for E.D. Physicians  Have equipment obtained & set up while you are doing the H&P  Don't X-ray the wound for foreign bodies if you can explore it directly adequately  Have staff obtain discharge meds & instructions while suturing is being done
  • 18. Charting Efficiency Techniques for E.D. Physicians Dictate/Write charts whenever free time is available o May split dictation (dictate initial H&P first ; then later add addendum dictation once lab & disposition are known)  Leave charts in the locations where they're supposed to be so time is not wasted tracking them down
  • 19. Interactive Efficiency Techniques for E.D. Staff  Don't be rigid about job duty performance o Helping someone else with their job may speed things up a lot o Extra attention should be directed to help the person who is the most busy  Let E.D. staff know your patient care plans so they can anticipate further actions  Have flexible room coverage assignments
  • 20. Improving E.D. Patient Flow Efficiency : Summary  All E.D. staff should take interest & pride in efficient patient flow  Anticipation and cooperation are key  "Mapping out" of short term events is helpful in planning  System should be geared to minimize time to initial ER Physician exam. & to make events simultaneous rather than sequential
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