ED Accreditation Update
ED cuts throughput from 3.2 to 2.3 hours
In making changes to address new accreditation standards on patient flow (LD.3.11), and surge capacity (IC.6.10), one hospital has reduced its average throughput in the ED from 3.2 hours to 2.3 hours. Additionally the ED has reduced its leave-without-being-seen (LWBS) patients from 6% to 4%, and registered LWBS patients have dropped from about 2.5% to 1%.
ED patients are registered at the beside, reports Rob Rose, RN, MS, CCRN, director of emergency services at St. Peter’s Hospital in Albany, NY. "Hardly anyone leaves after being registered."
The reductions are due to two new policies: one for patient placement and one for code capacity, he says. "We maintain about 90% capacity all the time," Rose says. "We have a couple of beds here and there."
To address the capacity issue, nurse managers attend three bed meetings a day, Rose says. They start the morning by discussing discharges. "We place surgical patients on the OR schedule, look at any ED patients waiting, then we do a wrap-up of how many beds are left," Rose says. At a 12:30 p.m. meeting, any new discharges, ED patients, or add-on surgical patients are placed. The group meets again at 3:30 to discuss the same patient groups. "We’re always looking for a bed," Rose says.
The code capacity (Code C) policy was written directly from the Joint Commission on Accreditation of Healthcare Organizations leadership standard about giving ED admitted patients the same level of care as inpatients. As part of that policy, white boards are placed throughout the hospital, including the doctor’s lounge, on the floors, in the ED waiting rooms, and by the OR doors. The board notifies patients, staff, and physicians that the ED and patient floors are experiencing volume constraints. The medical director and clinical directors of each service also are notified. "It’s a heads up," Rose says.
As the first phase of dealing with excess volume, the hospital places patients in areas designated for outpatients. The ED opens its fast-track area earlier to help deal with additional volume. Also, patients are placed in a lounge and other areas. The hospital has kits for these patients that include call bells, commodes, and lap trays.
"Obviously, managers are selective about who they put in those areas," Rose says. "We’re obviously not going to put a real sick patient there."
Female OB/GYN patients who are not infectious are taken to the floor that handles postpartum cases.
In the second phase to address excess patients, each unit takes two more patients in its hallways. Managers frequently put three patients in a room, Rose says. Because it is cumbersome to have bedside tables in hallways or in rooms for three patients, lap trays are used.
Source
For more information on reducing throughput, contact:
- Rob Rose, RN, MS, CCRN, Director of Emergency Services, St. Peter’s Hospital, 315 S. Manning Blvd., Albany, NY 12208. Phone: (518) 525-1550. E-mail: [email protected].
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