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Connecticut Children’s Medical Center asked Philips Blue Jay Consulting to help improve ED operational efficiency and patient throughput. An onsite consultant provided ED interim leadership and completed a comprehensive assessment. A second consultant joined to deliver a 6-month performance improvement project.
The consultants became an integrated part of Connecticut Children’s ED team and collaborated to improve operational performance. ED performance and patient throughput improved, including the below results:
“The Philips consultants were essential in helping us to work together and implement process changes which improved our ED performance and throughput significantly. They became part of our ED team.”
Cheryl Hoey, RN, BSN, MBA
Senior Vice President, Clinical Services & CNO Connecticut Children’s Medical Center
Exceptional Interim Leadership
As Interim ED Manager, the consultant focused on providing day-to-day operational and staff management as well as guidance on performance improvement opportunities.
She worked with staff members to implement new processes to improve team communications, staff development, daily rounds, patient flow, and management reporting. Staff-oriented focus supported the acceptance and hard-wiring of change.
Assessment
Our assessment team analyzed operational data, reviewed governance, roles, and responsibilities, agreed baseline performance metrics, and recommended an action plan.
Improvement opportunities were identified for front-end processes, patient flow, staff communication, training on ESI 5-level triage system with inter-rater reliability, and standardization of the charge nurse role. Connecticut Children’s requested a second consultant to lead a 6-month performance improvement (PI) engagement.
Improved ED performance
Based on the assessment, the PI consultant recommended prioritizing focus on charge nurse development, direct bedding, triage/front-end process, and throughput. A charge nurse training curriculum was created with focus on patient flow, resource management, change management, and conflict intervention.
The consultants helped implement new ESI triage training and processes aligned with the American Academy of Pediatrics standards.1 Inter-rater reliability helped validate triage assessments and ED patients were triaged according to the new ESI processes.
New Vital Signs processes
The ED Staff reported that a full set of pediatric vital signs (VS) were taking too long or not completed due to patient discomfort. According to the new ESI processes, blood pressure measurement and pulse oximetry was not necessary in all patients. Once the new processes were implemented, the pediatric VS issue dissipated. Nurses retained the autonomy to obtain a BP as clinically indicated if outside the established parameters.
Vital Signs completion decreased from 18 to 15 minutes – a 17% improvement. An unanticipated outcome of the project was a reduction in missing VS documentation.
Long-term interim leadership and Magnet submission
A year after the project start, Connecticut Children’s ED Director resigned and the consultant was asked to transition to that role as an interim resource. Another year later, the consultant was asked to extend oversight responsibilities to both ED and PICU.
As the interim ED and PICU Director, the Philips consultant provided significant contributions to Connecticut Children’s Magnet documentation and submission process to the American Nurses Credentialing Center (ANCC).
Results*
Connecticut Children’s Medical Center has sustained improved ED performance and increased patient throughput, including the below results:
1.American College of Emergency Physicians. Clinical & practice management: guidelines for care of children in the emergency department. Retrieved from www.acep.org/content.aspx?id=29134.
*Results from case studies are not predictive of results in other cases. Results in other cases may vary.
Karen Webb, MSN, RN, NEA-BC, NHDP-BC
Senior Consultant
Will Stewart, MSN, RN, CEN, EMT-LP, NE-BC
Consulting Principal
Emergency Department and Trauma Center Optimization
A hands-on approach to improving process efficiency in emergency departments and trauma centers, to help achieve operational, clinical, and financial excellence.