increasing patient throughput: outcomes of an ed ......-throughput • overcrowding mitigation •...

Shawn Zembles, DNP, APRNED CNS, St. Anthony Hospital

INCREASING PATIENT THROUGHPUT: OUTCOMES OF AN ED OBSERVATION UNIT

Key Team LeadersBeth Dunn, BSN, MHA, CEN

Martha Townsend, PA-C, DPTLaura Parrot, BSN, RN

Gerald Winston Tripp II, MD

ObjectivesThe participant will be able to:

◦Describe two sequelae of emergency department overcrowding

◦Articulate two of the benefits of an emergency department observation (Obs) unit

OverviewHealthcare policy

ED utilization

Historical perspective

Current demands

Future challenges

Overcrowding sequelae

• Throughput• Delays in care

• Department congestion

• Increased frustration

• Safety concerns

• Decreased satisfaction• Pt- unrealistic

expectations

• Noise & chaos

• Staff- burnout

Current StateSWOT Analysis

• Strengths

• Weaknesses

• Opportunities

• Threats

OpportunityNeeds assessment

Proactive response

Expand service line

Execution plan

Business proposal

- Pro Forma- Assumptions

- Cash flow

- Returns

Planning1. Capabilities

2. Space

3. Provider model

4. Nursing staff

5. Education and training

6. Target date

7. Fiscal needs

8. Continuous improvement

PIAPSharing of ideas

Staff-scheduling matrix

Workflow

Resource activation

Communication

Training

Response to BarriersSocialize till the norm

• Benefits

• Purpose• Overcrowding

• Enhance Throughput

• Manageable Assignment

• Process• 22 DRGs

• Approved

• Streamlined

Data AnalysisCensus

Average Census

• 229 per month• 8 per day

External transfers

• 7% increase• 16 per month

• $2,800 per day

• $44,800 per month

Areas to explore

• 4.5% of ED pts transfer to ED Obs

• 170 pts/month admit to IP Obs

• 20% potential miss rate that go to in-patient Obs & that qualify for ED Obs

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50

100

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ED Obs Census-Internal admits ED Obs Census-All admits

Census Results May to Sep 2017

May Jun Jul Aug Sep

5 month totals- 1065 5 month totals- 1143

Increased ED Observation census equals Improved ED throughput and surge capability

Comparative depts• ED• ED Obs• IP Obs

Satisfaction elements

• Measurable data• Overall• Recommend• Courtesy• Length of stay

• Anecdotal input• Larger room• More comfortable

bed• Better privacy• Less noise

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ED ED Obs IP Obs

Patient Satisfaction

Overall Recommend Courtesy

Data AnalysisPt Satisfaction

5.3 hrs 4.3 hrs 30 hrs 20 hrs

Outcomes & ConclusionBenefits of ED Obs Unit

- Throughput

• Overcrowding mitigation• Enhanced expansion capabilities• Throughput improvement• Reduced department congestion• Faster bed turnover• Evidenced by LOS data

- 19% quicker out of the ED- 33% shorter length of stay

Satisfaction elements

- now and then…

• 20 % increase in overallpatient satisfaction

• 20 % increase in likely to recommend SAH

• 37 % increase in courtesy & respect by providers

20,878 Collective patient hours relieved from main ED

Thank you