In-house 'Access Center' relieves ED bed burden
Unit: 600 calls, 425 unscheduled admits monthly
The creation of an "Access Center" to handle interhospital transfer coordination and unscheduled admissions at Saint Francis Hospital in Tulsa, OK, has taken a huge load off the ED and vastly improved the movement of patients into beds.
The center, which is now about 3 years old, has handled more than 20,000 transfer calls — averaging more than 600 a month and has handled about 425 unscheduled admissions a month, according to Darren Newkirk, MSN, RN, CCRN, clinical manager of the center.
"That's over 1,000 patients a month we are handling in a coordinated manner," he says. About 54% of transfer patients are direct admits, he says. "Of course, all the unscheduled admissions should be direct," Newkirk says. The remaining patients are ED check-ins or trauma patients at the 682-bed tertiary care facility, he says.
The center is centrally located in the hospital, with the bed assignment desk and nurses in the same room in close proximity — and about a minute's walk from the ED. It has two nurses and bed assignment staff on the day and night shifts. On the third shift, there are three nurses to provide after-hours telephone triage for 140 physicians. Most of the staffing was accomplished without adding personnel, says Newkirk.
"The nurses we brought over were already doing telephone triage," he says. "The bed assignment staff was already in admitting." He did add a single nurse on the day shift to function as bed management coordinator.
Having the center has changed processes significantly. For example, in the past, transfers were coordinated by Life Flight air ambulance dispatchers. "There were always issues that would come up concerning what was and was not a legitimate transfer, and which specialist to call for a consult," says Newkirk. "When we added the nurses, we trained them on EMTALA [Emergency Medical Treatment and Active Labor Act] and all about the transfer process." Complaints went down, coordination went up, and there was much better buy-in from physicians, he reports.
In the past, when physicians would call in unscheduled admissions, the admitting department would send them to one of five entrances, often resulting in delays in terms of getting them to the proper department. "Now all calls from doctors' offices or from homes go through the Access Center, and we coordinate the most appropriate entrance for them to come to," Newkirk explains. "We also notify the ED and tell them they are a direct admit, so they don't check them in."
This process takes a lot of pressure off supervisors, says Jan Emmons, MSN, RN, director of emergency services. "Someone else is making those phone calls to physicians, so we are more able focus on patient care," she says. "Plus, instead of filtering everything through our door, the Access Center handles many of the patients."
In addition, because patients go to the appropriate place more quickly, patient satisfaction is getting a boost, Emmons says. "If they need to be in the ED, they should be there, but if they are coming from another facility and the access center can make more appropriate arrangements, that's great."
Initially, the Access Center led to significant improvements in patient flow. In an article in the June 2005 issue of Journal of Emergency Nursing, it was reported that patient admission wait times were cut by 64% and there was a 40-minute decrease in bed assignment times for ED patients.1
However, in what has turned out to be a familiar "good news, bad news" scenario, the center also has led to a 9% increase in hospital admissions. As a result, "as we got more and more patients, our wait times started to go back up, and the number of patient denials because of bed availability also started creeping up," reports Newkirk.
In an effort to get on top of the situation again, Saint Francis plans to implement an automated bed board pre-admission system in July. "We are also working to bring in a dedicated admissions unit, so if there is no bed available, the patient can go there to be checked in and pulled out of the ED once we know they are going to be admitted," Newkirk says.
Regardless, Emmons is extremely happy with the Access Center. "I wasn't here when it was first opened, but the only thing I would have done differently would have been to make the move earlier," she says. "The burden taken off the ED staff has been unbelievable. I don't know how they did it before."
Reference
- Hemphill R, Nole B. Relieving an overcrowded ED and increasing capacity for regional transfers: One hospital's bed management strategies. J Emerg Nurs 2005; 31(3):243-246.
Sources
For more information on bed management strategies, contact:
- Jan Emmons, MSN, RN, Director, Emergency Services; Darren Newkirk, MSN, RN, CCRN, Clinical Manager, Access Center, Saint Francis Hospital, Tulsa, OK. Phone: (918) 494-2200.
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