Transforming ED flow and care delivery for optimal results

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By transforming ED flow and care delivery, hospitals can increase the number of patients seen in a timely manner and decrease the length of visit for each patient without boosting staff or expanding space.
At the HIMSS conference in New Orleans yesterday, Banner Health Directors of Management Engineering, Richard A. Andrews, BS, MBA, and Mary Ellen Bucco, BS, MBA, revealed how Banner’s Emergency Departments saw up to a 20 percent increase in patients who were seen within 30 minutes. They also reduced LWOT rates from 14 percent to less than 6 percent.

Banner Health increased hospital and physician productivity by examining ED metrics, studying arrival patterns of patients, discovering where the holdups (and bottlenecks) occurred, and looking at the door to doctor timeframe. Then they redesigned their entire process.
The most important factor was to get everyone to agree to the same procedure. They first minimized Emergency Department patient throughput by adopting a team approach for nurse and physician, who now work jointly during visits to speed documentation and eliminate redundancy. “We decided to throw out the ‘triage’ term,” said Bucco, because both the nurse and doctor were receiving the same exact information from the patient at two separate times during the visit.
After examining the science of throughput, they decided to base priority treatment on acuity. Banner Health realized that only level one and level two patients needed to go directly to a bed, and that level threes, fours, and fives could go to acute care. “Not every patient needs a bed or to get undressed. Does an 80-year-old lady who needs a prescription filled need to get undressed?” Bucco said. “That eliminates the 20 minutes it takes to get undressed, and the 20 minutes it takes to get dressed again,” she said.

By using technology and brain power, physicians were able to expedite flow, minimize door to doc times, and increase patient satisfaction. “Physicians realized that they are the single, biggest bottleneck,” Andrews said. “Now they’re actually doing better than seeing two patients an hour and working less.”