INCREASING PATIENT THROUGHPUT: OUTCOMES OF AN ED ......-Throughput • Overcrowding mitigation •...
12
Shawn Zembles, DNP, APRN ED CNS, St. Anthony Hospital INCREASING PATIENT THROUGHPUT: OUTCOMES OF AN ED OBSERVATION UNIT Key Team Leaders Beth Dunn, BSN, MHA, CEN Martha Townsend, PA-C, DPT Laura Parrot, BSN, RN Gerald Winston Tripp II, MD
Transcript of INCREASING PATIENT THROUGHPUT: OUTCOMES OF AN ED ......-Throughput • Overcrowding mitigation •...
Shawn Zembles, DNP, APRNED CNS, St. Anthony Hospital
INCREASING PATIENT THROUGHPUT: OUTCOMES OF AN ED OBSERVATION UNIT
Key Team LeadersBeth Dunn, BSN, MHA, CEN
Martha Townsend, PA-C, DPTLaura Parrot, BSN, RN
Gerald Winston Tripp II, MD
ObjectivesThe participant will be able to:
◦Describe two sequelae of emergency department overcrowding
◦Articulate two of the benefits of an emergency department observation (Obs) unit
OverviewHealthcare policy
ED utilization
Historical perspective
Current demands
Future challenges
Overcrowding sequelae
• Throughput• Delays in care
• Department congestion
• Increased frustration
• Safety concerns
• Decreased satisfaction• Pt- unrealistic
expectations
• Noise & chaos
• Staff- burnout
Current StateSWOT Analysis
• Strengths
• Weaknesses
• Opportunities
• Threats
OpportunityNeeds assessment
Proactive response
Expand service line
Execution plan
Business proposal
- Pro Forma- Assumptions
- Cash flow
- Returns
Planning1. Capabilities
2. Space
3. Provider model
4. Nursing staff
5. Education and training
6. Target date
7. Fiscal needs
8. Continuous improvement
PIAPSharing of ideas
Staff-scheduling matrix
Workflow
Resource activation
Communication
Training
Response to BarriersSocialize till the norm
• Benefits
• Purpose• Overcrowding
• Enhance Throughput
• Manageable Assignment
• Process• 22 DRGs
• Approved
• Streamlined
Data AnalysisCensus
Average Census
• 229 per month• 8 per day
External transfers
• 7% increase• 16 per month
• $2,800 per day
• $44,800 per month
Areas to explore
• 4.5% of ED pts transfer to ED Obs
• 170 pts/month admit to IP Obs
• 20% potential miss rate that go to in-patient Obs & that qualify for ED Obs
0
50
100
150
200
250
300
ED Obs Census-Internal admits ED Obs Census-All admits
Census Results May to Sep 2017
May Jun Jul Aug Sep
5 month totals- 1065 5 month totals- 1143
Increased ED Observation census equals Improved ED throughput and surge capability
Comparative depts• ED• ED Obs• IP Obs
Satisfaction elements
• Measurable data• Overall• Recommend• Courtesy• Length of stay
• Anecdotal input• Larger room• More comfortable
bed• Better privacy• Less noise
0
10
20
30
40
50
60
70
80
90
ED ED Obs IP Obs
Patient Satisfaction
Overall Recommend Courtesy
Data AnalysisPt Satisfaction
5.3 hrs 4.3 hrs 30 hrs 20 hrs
Outcomes & ConclusionBenefits of ED Obs Unit
- Throughput
• Overcrowding mitigation• Enhanced expansion capabilities• Throughput improvement• Reduced department congestion• Faster bed turnover• Evidenced by LOS data
- 19% quicker out of the ED- 33% shorter length of stay
Satisfaction elements
- now and then…
• 20 % increase in overallpatient satisfaction
• 20 % increase in likely to recommend SAH
• 37 % increase in courtesy & respect by providers
20,878 Collective patient hours relieved from main ED
Thank you
