Department of Emergency Medicine FY’06 Annual Report

1. Department of Emergency MedicineFY’06 Annual Report Michael Weinstock, MD David Burmeister, DO Richard MacKenzie, MD Anne Panik, RN, MS Alex Rosenau, DO Charlotte Buckenmyer, RN, MS John Wheary, DO Courtney Vose, RN, MSN William Bond, MD Christina Lewis, RN, MPH

2. LVH-CC GLOBAL Clinical Operations Regional & National Activities LVH-17th LVH-M Research Department of Emergency Medicine LVH-M Residency GHHA!!! (Hazleton General Hospital) Physician Assistants EM Residency Practice Management Internship Physicians Education EMS Allied Health Nursing Patient Transport GEM EMI • Critical Care Internship for GN’s • Nursing Students, RN & MSN/CRNP • Interfacility • Intrafacility • Transfer Center • Staff Education • EMS Education • Community Education • PA Students • EMS Students • Other Students Physician MedEvac LOCAL • Medical Students • Off-service Residents • MedEvac I • MedEvac II • MedEvac IV • MedEvac VII

3. FY’06 AT A GLANCE • ED Visits 119,077 • ED Admissions 23,216 (44% of LVHHN) • EM associated house staff from 36 – 39 • EMI >13,214 students in 1,311 courses • MedEvac 1,819 Completed Flights • NASCAR: 263 patients; 63 staff • Financial Gains

4. Tuning Triage Time (T3) Initiative Department of Emergency Medicine

6. T 3 TEAM LEADER ANNE PANIK RN, MS, CNAA,

7. Overview • Unmet demand • Data • Test results in system until disposition • Results recorded until DC instructions given • Disposition known until DC instructions given • Solution • Minimum Specific Goals • What’s in it for me? • Satisfy patients • Decrease increase of work with dissatisfied patient • Increase capacity • Decrease LOS • Better Care • Improved Press, Ganey • Better Community impression

8. Teamwork!!!

9. Implementation Date May 10, 2006

10. Minimum Specification Goal Increase Capacity in all of our ED’s • Better bed turnaround time = means to an end • Pay attention to all time intervals • Minutes count

11. Teamwork!!

12. T3 Process Grid No ED Beds Available ED Beds Available Wait for Triage • 2nd Triage RN • “Field” Triage Pts • Intake Form • Short Assessment No Wait for Triage • Full Assessment • Consider Nursing Testing by Protocol (POD 5) • Fast Bed Patients

13. ED-TTT LVH-M New Process / Decision Flow Chart Entry Greeter: 12:00 – 20:30 Registrar: 20:30 – 00:00 No Coverage: 03:00 – 06:30 Person talks to Greeter at Front Desk People other than Patients enter the ED Greeter helps Person (Directions, Open ED door, Patient Info) Patient? More than 2 Pts Waiting for Triage No Yes Important to ID pt and not create duplicate Med Rec # Triage RN contact Charge RN – Request Assistance Assist Pt? Triage RN helps Patient enter ED Yes No Alert Level 2+: Mini-Register Patient at Front Desk Name / DOB / SSN only More than 2 Pts Waiting Yes No Field Triage Triage RN Field Triage Patient Alert Level 2+ No XC Pt Determine ESI Yes Triage Empty? XC Bed Open? All other pts No Alert Level 2+ Yes No Yes Triage Patient goes in Triage Room Rapid Cycle: Put clock in Triage Room Pts Waiting for Triage Fast Bed Pt Triage RN views and assigns room (ED or XC) utilizing greaseboard. Pts Waiting for Triage Triage RN Initiates Template Patient given Intake Form. Greeter adds time. Registrar does Full Reg Registrar does Mini-Reg Yes No Patient taken to Bed Patient returns form. Patient in Waiting Room Problem can arise if information in LastWord does not exactly match information in T-System. Bedside RN Does Assessment Triage RN takes vitals, allergies, Chief Complaint, Assessment of Critical meds (eg Blood thinners) and history relevant to chief complaint at Nurse’s discretion Triage RN “triages” Intake Forms. Registrar does full Bedside Registration Triage RN calls Patient Triage RN assigns ESI

14. P3 Are we doing the right thing?

15. Elopements Decrease! • 17th • Pre - 2.2% • Post – 1.7% • CC • Pre – 2.9% • Post – 2.0% • M • Pre – 1.7% • Post – 1.6%

16. T3 Waiting Room Times Door to Bed times have improved by an average of over 10 minutes since T3/P3 Go-Live. Door to Bedtimes have improved by an average of over 7 minutes since T3/P3 Go-Live.