Overcrowding-Related Process Improvement Activities in the Adult ED (Excerpt)
Things Currently Being Done
- Triage Area
- Triage criteria prioritize patients by acuity.
- Patients with chest pain have electrocardiogram performed and read by faculty or senior residents.
- Patients at risk for tuberculosis have chest X-rays taken and read by faculty or senior residents.
- Emergency medicine residents care for lower-acuity patients in the triage area from 7-11 p.m. daily (moonlighting).
- Supervision of House Staff
- Senior residents quickly screen and write initial orders on all new patients placed in ED beds.
- All patients evaluated by medical students, interns, and junior residents are presented to senior residents or faculty before tests or consultations are ordered (during the first four months of the academic year) to prevent unnecessary tests or consultations.
- Discharge Process
- Patients in beds who are discharged from the ED are moved to sit in a discharge area to await discharge instructions (so beds can be filled more quickly with new patients).
- System Changes
- The Patient Flow Facilitator Program ensures appropriate and efficient use of an inpatient monitored bed.
- The ED Crisis Management Program facilitates the downgrade and discharge of inpatients when the ED has more than seven patients awaiting inpatient monitored beds.
- The Chest Pain Program developed with Cardiology decreases unnecessary admissions by providing short-term outpatient follow-up and evaluation of low-risk patients with chest pain.
- Criteria were developed for closure to ambulance traffic and inter-facility transfers (now adopted countywide).
Additional Projects Under Way
- Triage Area
- Triage criteria are currently being reviewed and modified to better identify high-risk patients.
- Dashboard Measures
- We are developing (with IS) a process for tracking patient flow times through the ED on a month-to-month basis (to measure the effects of future process improvement activities).
- Create Greater Capacity in Non-ED Areas
- Expand Urgent Care hours.*
- Create additional inpatient Progressive Care Unit beds.*
* NOTE: These things have been funded and should be implemented within the next several months.
- Improve Turnaround Times for Radiological Tests
- Develop mechanism for using additional computed tomography scanner (in basement) when necessary.*
* NOTE: This request has been OK’d by Administration, and a program is being developed.
The Future
- Hospital Patient Flow Committee
Hospital leadership has formed a Patient Flow Steering Committee that will oversee the work of an ED Patient Flow Subcommittee and an Inpatient Patient Flow Subcommittee. The subcommittees are charged with finding ways to improve patient flow through the hospital (from initial presentation at the ED triage area to hospital discharge).
Source: Robert S. Hockberger, MD, FACEP, Chief of the Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, in Torrance.
Things Currently Being Done Triage Area Triage criteria prioritize patients by acuity. Patients with chest pain have electrocardiogram performed and read by faculty or senior residents. Patients at risk for tuberculosis have chest X-rays taken and read by faculty or senior residents. Emergency medicine residents care for lower-acuity patients in the triage area from 7-11 p.m. daily (moonlighting).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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