Best practice management in emergency medicine – latest approach
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Transcript of Best practice management in emergency medicine – latest approach
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 [email protected]