Goal: Patient upstairs in fewer than 60 minutes
At Overlook Hospital in Summit, NJ, ED staff set an ambitious goal: to reduce admission cycle time to fewer than 60 minutes. According to Linda Kosnik, RN, MSN, CS, the ED’s chief nursing officer, the following steps were taken to achieve this goal:
• A multidisciplinary team was created with all areas related to admission cycle time including nursing staff, secretaries, technicians, transporters, registration, and bed control.
• Before the first meeting, data were collected on turnaround time from the time the decision was made to admit the patient to the time the patient actually left for the unit.
• Bed control was put under ED leadership.
• Senior administrative support was obtained.
• A "czarina of bed control" role was added, so that someone on a high management level was able to intervene if needed.
• A data collection process was created.
• Admission and discharge criteria was created for all units so that no single unit becomes overloaded while the others are not. Each unit was "capped" at a certain number so that it must only take "its" population, or diagnoses specific to that unit, says Kosnik. "This prevents patient transfers later and supports better patient outcomes," she adds.
• A "demand capacity" management system was developed. "The system is based on the premise that divert or bypass is the end result of a meltdown in the inpatient services," says Kosnik. "The management of inpatient flow is therefore paramount to avoiding ED flow breakdown."
• Delays are continuously monitored via a computer screen, which are displayed for the previous three hours in 15-minute blocks of time. (To see sample screen, click here.) Algorithms are in place so the system can adapt to current demand, based on specific thresholds.
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