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Optimizing Emergency Department Utilization Presented by Brenda Lee, R.N., M.S.N.

Optimizing Emergency Department Utilization Presented by Brenda Lee, R.N., M.S.N. TEAM MEMBERS. CS&E Session 13 Participants Joan Hall, Quality Don Hunt, CNO Dr. Gregory Johnson, Medical Director of ED -ED Staff, Physicians, and Residents. Background.

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Optimizing Emergency Department Utilization Presented by Brenda Lee, R.N., M.S.N.

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  1. Optimizing Emergency Department Utilization Presented by Brenda Lee, R.N., M.S.N.

  2. TEAM MEMBERS • CS&E Session 13 Participants • Joan Hall, Quality • Don Hunt, CNO • Dr. Gregory Johnson, Medical Director of ED • -ED Staff, Physicians, and Residents

  3. Background • The mean # of patients LWBS is 12 per month (ADV 40) • Patient Satisfaction scores for wait time and informed about delays were two areas needing improvement • Triage process variation between shifts • Patient safety and risk concerns (urgent patients not receiving care, EMTALA violations, and financial loss) • Information regarding factors associated with patients, physicians, and environment (acuity, length of stay, resource utilization, long wait time, non-urgent patients with improved condition, etc.) was not available

  4. What We Are Trying to Accomplish? PROJECT AIM STATEMENT Reduce the number of patients who leave without being seen (LWBS) in the Emergency Department by 50% (approximately 6 patients) per month.

  5. How Will We Know That a Change is an Improvement? Reduced # of patients who leave without being seen by a physician Accurate correlation of triage level to patient wait and disposition Improved patient satisfaction for wait times and delays

  6. Time of Day LWBS April 2009 – April 2010

  7. Interventions • Create a paradigm shift for ED staff to optimize throughput for all patients (not just emergent) • Design a standardized sign in process • Develop follow-up process for patients that LWBS to identify associated patient characteristics • Address patient expectations for wait time and implement a process for communicating delays • Analyze data related to physician and environmental characteristics (triage, resource utilization, etc.)

  8. Results

  9. Average ED Visit cost $450 per patient X 157 patients = *$70,650 *Annualized Potential Revenue for Patients that LWBS

  10. Conclusions/What’s Next • Process change for admitting patients during the day shift decreased ALOS for these patients however, mean wait time for discharged patients did not demonstrate a significant decrease. • Addressing expectation of wait times is instrumental in deterring patients from leaving without being seen. • Data validated the need for implementation of the ESI 5 level triage system to standardize staff utilization of resources and further increase efficiency of patient treatment; particularly for potential admissions. • Staff will plan the design and implementation of a parallel process flow utilizing nurse initiated protocols while “keeping patients vertical” and moving to decrease the length of stay for non-urgent patients that are expected to only increase in the future.

  11. Questions?

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