ED, discharge units improve patient flow
LWOS numbers down
As bed management coordinator at Wake Forest University Baptist Medical Center in Winston-Salem, NC, Jonathan Morris, RN, has been indirectly involved in creating an emergency department (ED) holding unit that has been successful in reducing the percentage of patients who "leave without being seen" (LWOS) — a commonly used measurement to monitor customer service.
The 10-bed holding unit was initiated at the end of 2003, Morris explains, to improve ED throughput by accommodating patients still being screened for various conditions, or waiting for inpatient beds.
The unit is designed for patients awaiting a clinical decision or "rule out," he says. "We don't put higher level of care patients in there.
"It's hard to say what helped the most, between [the holding unit] and coming on the preadmit tracking board, but [the ED] is now below the national average for percentage of patients who leave without being seen," Morris notes. Formerly between 4% and 6%, he adds, the hospital's LWOS rate is now 2% or below.
The verdict is still out, Morris says, on a recently opened discharge holding unit, another initiative aimed at enhancing patient flow. The unit — open four days a week, 10 hours a day — is for patients who have discharge orders written, he adds.
"They might be waiting for home health supplies or medication from our pharmacy to be delivered, or just for a ride home," Morris explains. "Many of our patients live two or three hours away."
Those who meet discharge criteria are transferred to the unit, which is located on the main floor of the hospital, next to the area where family members drive through to pick up departing patients, he says.
The discharge holding unit provides another way to use the electronic bed board, Morris notes. "It shows pending and confirmed discharges on the units. Nurses in the discharge unit have access to this, so they can police it to see where these discharges are located. They will call the [nurses on the unit] and remind them."
This proactive approach is part of "pulling" the patient to the next step in the throughput process, rather than "pushing" from the previous location, he says. "The old way was [for unit nurses] to hold off [on moving the patient out] because there is all this other stuff to be done."
His belief is that the receiving unit — for example, a regular unit due to receive a patient from the intensive care unit — should offer to go and get the patient if time allows, Morris says. Traditionally, he notes, it has always been the transferring unit's responsibility to take the patient to the next location.
Financial discharge area added
In addition to the new clinical discharge area, points out Keith Weatherman, CAM, MHA, associate director for patient financial services, there is a new financial discharge area, located nearby. The idea is to offer financial counselors the chance to get a last piece of necessary information, he says, as well as to provide the opportunity for patients to pay the liability portion of their bill before they leave.
Financial counselors' hours have been adjusted, Weatherman says, to accommodate the new discharge station, which is open until 7 p.m. It is under the supervision of the manager of financial counseling, who also oversees ED registration, he adds.
"It's been a great patient convenience," Weatherman says. "We have collected money in that area, rather than waiting until statements go out."
The 10-bed holding unit was initiated at the end of 2003, Morris explains, to improve ED throughput by accommodating patients still being screened for various conditions,...You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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