Focus International News TV BS Taiwan*.

Best practice management in Best practice management in emergency medicine emergency medicine –– latest approach.latest approach.

>350 patients/day>350 patients/dayMay 20 2014

Michael Hansen-Nord, MD, Head of Department

Odense University Hospital, Denmark

We have to deal with

1. Overcrowding

2. Staff1. Stress

2. High % of absence1. 8 – 10 %

3.

Patients in ED, OUH

127.000

(350/day)

60.000Emergency services

(7 hours daily)

40.000Somatic fast-track

27.000Triage (admittance?)

(2/3 of all)

Patients/year

(average)Categories

Identify paradigmes..

1. Consultant in front2. Standardization 3. Do things on time .. Don't pros pone4. Diagnostic packages

1. standardization5. 4 hours to diagnose6. Synergy by performers7. M.fl.

Challenges?

1. Standardization1. Processes

2. Logistics

3. Professional approach

Standardization

1. Processes

Emergency Emergency service.service.

Admittance?Admittance?

Fast trackFast track

Blue patientsBlue patients

Cut down to 3 different tracks

Competences ProcestimeProcesses ”green”

180Waiting timeconsultant30Evaluation

X-ray and lab.360Answers on diagnostics

Resident90Medical recordSkilled nurse10Triage

Nurse15In-bed proceduresSecretary5Pre visitationSecretary5Registration

11,5 timer

Keep the patients in flow

1. 4 hours stay in ED2. All acute diagnostics should be at

hand before the patient leaves the ETC.

3. Introducing TRIAGE (ADAPT) for all patients.

4. 70 % discharged < 48 timer

The challenge…!

1. Passing time in ED 4 hours. 1. 14 – 18 staff members needed

2. > 85 % of the patients are yellow or green in triage

1. They do not need immediate action

2. …but they should be kept in flow also

Triage - ADAPTRed

Orange

Green

Yellow

Rescusation

Blue

Admittance ?

160

Nurse2 eller 515Initial nursing

Nurse2 eller 510Stafet

Internist245Patients file

Senior doctor215Senior doctors evaluation

4Waiting area

Radiologist315Radiology

Lab. technician215Blood-analysis

Nurse and senior doctor220Triage and visitation

Nurse215In bed

Nurse15Previsitation

Secretary15Registration

240Total minutes in the acute area

Staff … competencesLocationMinutesTime pr. process

Simulation options?

� Staffing

� First edition of standardized, process-driving patient tracks

� Variations over the day/month/year

� Bottlenecks?

� Chaos-handling

Standardization

1. Logistics

Conference

Conference

Logistics in ED

Logistics in ED

Who's next?

Logistics in ED

How fare are we?

Logistics in ED

Time from arrival – to meet the 4 hour criteria?

Standardization

1. Professional approach

Incoming patients

1. We don't know them by diagnose1. ..do you?

2. ..but we know them by symptoms1. 34 somatic symptoms (97%)2. 5 psychiatric symptoms

From diagnose- to symptom based visitation

1. Visitation by suspected diagnose1. Obs. MI2. Obs. Appendicitic3. Etc.

2. Visitation based on symptoms combined by triage-color

1. Chest-pain and red2. Abdominal pain and orange3. Etc.

Diagnostic packages (DP)in the region of Southern Denmark

1. 34 somatic DP and 5 psychiatric2. Recipe on what professional output a sudden

somatic symptom must provoke1. Blood samples2. Radiology

3. Part of the triage-process

Yes – we perform!

1. ½-hour criterion1. Average 41 minutes

2. 4- hour criterion1. Average 3 hours 51 minutes

3. Not admitted?1. 60 to 75 %

4. Average admittance in ED?1. 18 to 13 hours

Thank You for Your attentionMichael Hansen-Nord michael.hansen-nord@rsyd.dk