Primary Author: | Veronica Palustra, RN, MSN |
Co-Principal Investigators/Collaborators: | Lily Wu, RN, Lotta Mae Alba ,RN, Kathleen Munro RN |
Organization: | El Camino Hospital |
Abstract
Purpose
Length of stay (LOS) is measured when the patient arrives in the Emergency Department (ED) to the time the patient is admitted to the hospital. Increased LOS leads to higher cost to the patient, organization, and higher mortality and morbidity. The Joint Commission cites poor communication as the number one root cause of sentinel events and is greater cause of patient dissatisfaction than the actual LOS.
Background
To provide a seamless transition from Emergency Department to hospital admission, an interdisciplinary team of frontline staff from ED, medical surgical, and telemetry units collaborated to define safe, timely, and efficient care to improve the patient experience.
Materials & Methods
Front-line staff participated in a rapid process improvement (RPI) utilizing “Lean” methods (from the Toyota Production System) to improve patient throughput. By holding ourselves accountable, we eliminated waste through identifying non-value-added activity (NVA) to achieve a more positive patient experience. Patients were brought to a room immediately after being triaged driven by availability. A provider and nurse met simultaneously with the patient to discuss the plan of care, improving communication while keeping the patient informed. The Interprofessional team created “the plan of care” form. Each patient received the name of the provider, nurse and estimated wait times for lab results and procedures. A standardized communication process was developed where inpatient nurses reviewed the ED patient handoff summary in the electronic medical record (EMR) and would communicate with ED nurses for questions or updates improving organization and collaboration for meaningful inpatient transfer. ED physicians and hospitalists collaborated on specific diagnosis for bridging orders and standardized the admission order set for safe and efficient throughput.
Results
In 13 months, LOS decreased from 295 to 275 minutes. Our ED to inpatient goal is 280 minutes.
Conclusion
Collaboratively, the team decided on solutions based on real time data and feedback from daily huddles. To sustain a culture of continuous improvement, transparency is vital and requires commitment from all.
Bibliography
- Baker, S. J. (2011). Key Words: A Prescriptive Approach to ReducingPatient Anxiety and Improving Safety. JEN: Journal Of Emergency Nursing, 37(6), 571-574.
- Emerman, C. L. (2012). National reporting of emergency department length of stay: challenges, opportunities, and risks. JAMA: Journal of the American Medical Association, 307(5), 511-512.
- Holden, R. J. (2011). Lean thinking in emergency departments: a critical review. Annals of Emergency Medicine, 57(3):265-78. doi:10.1016/j.annemergmed.2010.08.001
- Horwitz, L. I., Green, J., & Bradley, E. H. (2010). US emergency department performance on wait time and length of visit. Annals of Emergency Medicine, 55(2), 133-141.
- Huang, Q., Thind, A., Dreyer, J. F., & Zaric, G. S. (2010). The impact of delays to admission from the emergency department on inpatient outcomes. BMC Emergency Medicine, 10, 16-21. doi:10.1016/j.annemergmed.2009.07.023
- Institute for Healthcare Improvement. (2011). Going lean in health care. Retrieved from http://www.ihi.org/_layouts/ihi/login/login.aspx?ReturnURL=%2fknowledge%...
- Joan Wellman & Associates. (2012). Lean Strategy Training Manual. Joan Wellman & Associates, Inc.: Mountain View, CA.
- Johnson, A. (2010). The customer's always right: steps you can take to ensure customer satisfaction. JEMS: Journal Of Emergency Medical Services, 35(3), 92-96.
- The Joint Commission. (2012). Standards revisions to address patient flow through the emergency department: hospital accreditation program. Retrieved from: http://www.jointcommission.org/assets/1/18/Pre_Publication_EDO_HAP.pdf&n...
- The Joint Commission. (2007). " What did the doctor say?”: Improving Health Literacy To Protect Patient Safety. Retrieved from: http://www.jointcommission.org/assets/1/18/improving_health_liter
- Kippax, C. C., & King, D. D. (2011). Patient satisfaction with a nurse-led service in an emergency department:. Emergency Nurse New Zealand, 12-20.
- Liu, S. W., Thomas, S. H., Gordon, J. A., Hamedani, A. G., & Weissman, J. S. (2009). A pilot study examining undesirable events among emergency department–boarded patients awaiting inpatient beds. Annals of Emergency Medicine, 54, 381.
- Mazzocato, P., Forsberg, H. H., & Schwarz, U. (2011). Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19, 70.
- National Research Council. (2007) Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: The National Academies Press.
- Nelson, E. C., Batalden, P. B., & Godfrey, M. M. (2007). Quality by design : A clinical microsystems approach. San Francisco: Jossey-Bass/Wiley.
- Pytel, C., Fielden, N., Meyer, K., & Albert, N. (2009). Nurse-patient/visitor communication in the emergency department. JEN: Journal Of Emergency Nursing, 35(5), 406-411.
- R. McCaffrey, R. Hayes, A. Cassell, S. Miller-Reyes, A. Donaldson, C. Ferrell. (2011). The effect of an educational program on attitudes of nurses and medical residents towards the benefits of positive communication and collaboration. Journal of Advances Nursing, pp. 293-300.
- Thompson, D., Yarnold, P., Williams, D., & Adams, S. (1996). Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Annals Of Emergency Medicine, 28(6), 657-665.
- Wellman, J., Jeffries, H., & Hagan., P.(2010). Leading the Lean healthcare journey: Driving culture change to increase value. Boca Raton, FL: CRC Press.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).