Acute unscheduled care in seven developed nations
Philips has sponsored an in-depth assessment of acute unscheduled care, the demands on acute care providers, and use of the emergency department across 7 countries. This research paper explores the similarities and differences in the factors leading to acute unscheduled care demands, care decision making, and care delivery in the ED and beyond.
To understand the issues, a consulting team visited onsite and through observations, data analysis, and interviews with stakeholders and staff, obtained a solid understanding of the operational challenges and opportunities.
ED walkout rates were at 7% related to poor front-end processes, particularly a lengthy triage process. Numerous human resources had been applied to the problem as well as some process changes but improvements were not sustained. Door to provider times were the worst in the region at 147 minutes. Lengths of stay (both admit and discharge) were double established benchmarks
Based on the assessment, a project plan was established that focused on front-end redesign, streamlining of documentation, and improvements in the admitting process. Two consultants were utilized to support the project. One consultant focused on the process improvement activities, leadership development, and triage training. The other, serving as interim director, provided department leadership to support the needed changes. A new organizational structure was put into place with robust leadership development training for all existing ED leaders.
To design the process changes, staff-driven work teams were utilized. The Philips Blue Jay Consulting process improvement consultant facilitated the teams and guided the staff through the redesign process. Staff champions were identified and they assisted with the implementation. A different team was established for each improvement project and the efforts were sequenced such that staffing demands on the unit were tolerable and the pace of change was sustainable.
Project updates were provided at biweekly steering committee meetings that alternated with updates to the executive team. Metric performance was reviewed daily and posted in the department. The data was also discussed in pre-shift huddles.
The teams implemented the following solutions:
• Nurse greeter and rapid registration
• Rapid triage by an RN on all ambulatory patients within 5 minutes of arrival followed by immediate bedding
• 100% bedside registration
• Triage documentation was streamlined thereby reducing the time to complete from 10 minutes to less than 1 minute
• Secondary triage if no beds were available, where a more in-depth assessment could occur and testing could begin on patients who were waiting for bed placement
• Fast Track criteria were established and use of space focused on keeping the patient vertical (use of chairs versus beds) and development of fast track sub-waiting area and results pending waiting area
• Development of admitting order sets to expedite the admission process
Rick has over 30 years of emergency, trauma, and physician practice leadership experience. He led a Level 1 trauma center ED and has reduced door to provider times, the decision-to-admit to inpatient bed times, implemented point-of-care testing in the ED, and streamlined nursing workflow and the ED discharge process. Rick is a certified nurse specializing in emergency nursing.
Learn more about our consulting capabilities for emergency care improvement for your healthcare organization
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