Emergency Department Patient Throughput: Evidence Based Practice Implementation
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2015-05
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University of Hawaii at Manoa
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Objectives: Emergency Department (ED) patient throughput is widely recognized as a major challenge for U.S. hospitals. When EDs are unable to efficiently manage the flow of patients, they are unable to accept new arrivals, and patients experience long lengths of stay and delays in access to needed care. The objective of this scholarly project was to evaluate the impact of evidenced based practices (EBP) on efficiency, access, safety, patient experience and hospital revenue. Methods: A prospective quality improvement design was used to implement and evaluate the EBPs. Four practices were selected for implementation including a split-flow model of triage with nurses and providers co-located in intake, point of care testing, a hospitalist assigned as admissions liaison, and a bed logistics management process. The scholarly project implementation occurred over an 18-month period with staggered dates for each EBP. Key performance data were collected prior to implementation and trended over the project period. Specific performance measures included: use of ambulance diversion, rates of left without being seen, patient arrival time until evaluated by provider, length of stay for discharged and admitted patients, patient satisfaction, and revenue impact to the hospital. Results: There was a 6% increase in ED visit volume during the project period. Ambulance diversion decreased by 97%. Positive trends were seen in left without being seen rates, length of time until evaluated by a provider, discharge length of stay, patient satisfaction with wait times and hospital revenue. Results were not favorable in time taken to transfer patient from ED to the inpatient hospital unit. Conclusions: Positive results were experienced with implementation of the EBPs. The implementation required executive leadership prioritization and inter-professional team engagement, as well as complex system strategies. Patients’ overall satisfaction with the ED experience was not substantially impacted even though these patients were more satisfied with the wait times for emergency care.
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Evidence-based practices, patient throughput, emergency department, crowding
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Theses for the degree of Doctor of Nursing Practice (University of Hawaii at Manoa). Nursing
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