| Primary Author: | Hannele E. Saunders, MS, APRN,BC, CNS, CNRN, RN,C |
| Organization | Helsinki University Central Hospital, Surgery Division |
Abstract
Purpose
To improve the effectiveness of emergency nursing care delivered to patients in the ED of a large University Medical Center, while simultaneously ensuring the timeliness of patients’ access to emergency treatment.
Background
The ED had been overcrowded for several years, which had caused dissatisfaction both in the patients and the ED staff. A critical systems analysis of the ED’s clinical intake process revealed that the ED became overcrowded, because patients came into the ED without a referral when obtaining one would have been possible, and they were customarily seen in the ED, as were those who had non-emergency care needs. The ED had also routinely given out ED appointments to patients with non-emergent clinical problems, simply because the urgent care outpatient clinic did not have enough acute care appointments available.
Materials & Methods
This ED clinical process change was implemented by conducting a study of patients’ ED visits, by analyzing visit trends, and by selectively increasing the number of clinical ED staff during peak times for overcrowding in the day shift. Division of labor between ED MDs, RNs, and clinical secretaries was clarified by developing standardized instructions for all major clinical ED processes. Steps were taken to improve interdisciplinary collaboration and increase the number of independent nurse clinicians working in triage. Collaboration between outpatient care providers and the hospital’s ED Dept. was strengthened by improving clinical consultation opportunities and lines of communication.
Results
The average length of patient ED visits during peak times (total throughput time) was significantly reduced after the implementation of the clinical process change. Additionally, the number of those ED patients, whose total patient visit had lasted over 8 hours decreased significantly, as did negative written feedback from ED patients, while ED patient volumes simultaneously increased.
Conclusion
Evidence-based clinical systems process change implemented via interdisciplinary collaboration can significantly improve the effectiveness of ED care, while still ensuring patients’ access to emergency treatment without delay.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).