Improving Emergency Department Throughput Time
HCS/587
October 1, 2012
Improving Emergency Department Throughput Time
Hospitals are experiencing patient congested emergency departments. At Baptist Memorial Hospital, the increase in patient volume and limited capacity contributes to long length of stays and patients leaving without being seen. As a result of overcrowded emergency rooms, patient length of stay becomes more important. Throughput times in the emergency department (ED) play a substantial role in patient and staff satisfaction. Length of stay in the ED is directly related to patient volume, patient acuity, lab turnaround times, and time to treatment, which is all connected to patient satisfaction. Long wait time
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Efficiency or streamlined processes are necessary to see and treat the number of patients presenting.
A specific problem that contributes to increased length of stay and delayed diagnosis is the timely result of urinalysis. The root cause of delayed urinalysis results is attributed to failure to collect, failure to transport, and failure to order. On a regular basis, the physicians wait on urinalysis reports when all other ordered lab has resulted. In exploring the possible causes of delayed results, it was discovered that when a urinalysis was ordered, many times the patient could not void. Therefore, the urine was not collected and soon forgotten by the nurse. Additionally, urines collected were not transported to the lab. The patient was provided with the specimen cup and collected the urine, but it was left sitting at the bedside even though the lab technician might have been in the room. Last, a problem exists with collecting urines but failing to order the test. Nurses implement protocols but fail to order the test in the system.
In a simulation study, significant improvement in ED efficiency was shown with decreasing lab turnaround time (Storrow, et al., 2008). As stated in the article, “the development of simulation models has been driven by nationwide increases in ED patient census and acuity, as well as ED closures and hospital overcrowding” (Storrow, et al., 2008, p. 1131). This study highlighted
A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly
14 million Canadians visit Emergency Departments (ED) every year, and also reported to having the highest use of EDs (Ontario Hospital Association, 2006). ED overcrowding in Canada has become an epidemic. ED overcrowding has been defined as “a situation in which the demand for emergency services exceeds the ability of an (emergency) department to provide quality care within acceptable time frames” (Ontario Ministry of Health and Long Term Care, 2014). This has been an ongoing problem across Canada. Ontario has developed an initiative to reduce ED wait times by implementing a variety of strategies and collaborating with other institutions. This paper describes the Emergency Room National Ambulatory Intuitive (ERNI), an
When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need
St. Vincent’s Medical Center, a 501 bed facility located in Jacksonville, Florida, provides general medical and surgical care to the North Florida Region. St. Vincent’s admits over 26,000 patients annually. The average occupancy rate is approximately 84% with the Emergency Department (ED) peeking at 100% for approximately 4-12 hours daily. The hospital is struggling with availability of bed space. This shortage of available beds creates a bottleneck in the ED on high census days. Bottlenecks are created in the ED when there is a shortage of inpatient beds to place admitted ED patients. Thus, patient flow, or throughput, is becoming more and more important.
The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3
And finally, by increasing funding for doctors, the waiting time in emergency rooms would decrease significantly by enabling the hospital to staff more doctors during the busy hours of the day. It would allow the hospital to staff additional doctors at night as well. These steps have been taken in some hospitals with great success. Hospitals have begun to communicate the expected wait times to their patients, one hospital even goes so far as to post waiting room times on the internet in real time, as of July 20 2007 at 19:31 the wait in the 5 hospitals listed ranged between 0 2 hr 40 minutes with the average being about
Emergency department (ED) overcrowding has become an international health crisis and been identified as a major threaten to public health. As defined by Australasian College for Emergency Medicine, overcrowding is a situation in which ED patients’ demand for services exceeds the staffing capacity to provide care within a reasonable length of time, thereby impeding ED function. Some has called ED as the safety net of the health care system, given its unique role in public health. However, the increasing problem of crowding and the associated impacts has strained this safety net to the “breaking point”. ED overcrowding and prolonged waiting time are associate with adverse consequences towards quality of care and patient safety, as well as
The Centers for Disease Control and Prevention (CDC, 2017) notes the following statistics pertaining to Emergency Department (ED) visits in the United States during 2013: (a) number of visits-130.4, (b) number of injury-related visits-37.2 million, (c) number of visits per 100 persons-41.9, (d) number of ED visits resulting in hospital admission 12.2 million, (e) number of ED visits resulting in admission to critical care unit-1.5 million, (f) percent of visits with patient seen in fewer than 15 minutes-29.8%, (g) percent of visits resulting in hospital admission-9.3%, and (h) percent of visits resulting in transfer to a different (psychiatric or their) hospital-2.2%.
“Long wait times could potentially result in worse patient outcomes, greater patient suffering, patient dissatisfaction, more difficulty retaining and recruiting staff, a higher risk of infectious disease outbreaks and an increased risk of medical errors” (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 456). This article explored how the addition of nurse practitioners and physician assistants in 6 Ontario emergency departments could help to reduce wait time, patient flow, and the number of patients who left without being seen (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 455). This study was seen to be the first of its kind in analyzing effects in an emergency department on patient flow by adding nurse practitioners and physician assistants to the healthcare team (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 459). The quantitative study design used for this study was the experimental design since it was based on implementation and evaluation of the effects (Keele, p. 41). The article does not address how the sample size was determined and actually
In this table, number 1 has the highest mean (3.07), for “Adequate support services allow me to spend time with my patients.”. This finding is consistent with the reality of hospitals allowing for laboratory, x-ray, pharmacy, and other services easily accessible to emergency patients. In addition, physicians are permanently stationed in the
When will I see a Doctor? When will I get a bed? These are the questions that are constantly asked when in the Emergency Department (ED). The Canadian Association of Emergency Physicians (CAEP) & National emergency Nurses Affiliation (NENA)(2003) defines overcrowding as a situation where “services exceeds the ability to provide care within a reasonable time, causing doctors and nurses to be unable to provide quality care” (“ED overcrowding”, para. 2). Maintaining access and flow in the ED is essential to the improvement of overcrowding. I am in agreement with the people of Ontario, who state that it is frustrating to wait for hours just to see a doctor or to be transferred to an in-patient unit. Firstly, overcrowding
Today, overcrowding affects the viability of emergency departments across this county (Derlet, 2002). Emergency department overcrowding refers to an excess of patients in the treatment areas exceeding ED capacity. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), over one half of all sentinel event cases of morbidity and mortality resulting from delays in treatment occur in hospital emergency departments. Emergency department overcrowding has been cited as a contributing factor in 31% of these sentinel event cases. (Trzeciak & Rivers, 2003). Consequently, overcrowding affects persons who suffer an unexpected severe illness or injury requiring time sensitive emergency treatment. Therefore, patients must
There are consistent reports across all studies that show overcrowding and patient flow is a big challenge at the emergency department (ED) that affects the quality of patient care. Bahena and Andreoni (2013) included increasing the number of patients, untimely and inefficient primary care, frequent flyer, special circumstances such as influenza season, and the change in the health care delivery system as reasons contributing to overcrowding. DeFlitch, Geeting, and Paz (2015) mentioned that overcrowding can be associated with less timely care, decreases patient satisfaction, ineffective care, and poor outcome. Quattrini, and Swan (2011) revealed the consequences of overcrowding as risk of poor patient outcome, lengthy waiting times and boarding
Capacity issues are something hospitals are facing more and more every day. Patients who have been admitted wait sometimes for hours up to days for a bed to open up on an inpatient unit. This delay takes up bed space and resources in the Emergency Department leading to increased delays for others to be seen. Waiting to be seen is a huge dissatisfier to our clients and can pose a safety risk when patients are not seen quickly.
Emergency rooms locally and nationwide are inundated with patients. Due to extended wait times, patients often suffer permanent damage or even die awaiting treatment. More often, others leave without being seen by a healthcare provider. The current problem of extended wait times prevents ER 's from delivering quality patient care in a time efficient manner. Wait times and overcrowding often results in negative and/or poor patient outcomes. It is this nurse 's belief that evaluation of triage tools and implementation of the most effective tool could serve to decrease patient wait times and reduce negative patient outcomes. Triage is often the first point of contact between the nurse and the patient. The triage assessment conducted by the nurse often determines the level of care the patient will receive. The triage assessment tool must be accurate in determining prioritization of care as well as