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Patient flow efficiency techniques in emergency department
1. PATIENT FLOW EFFICIENCY
TECHNIQUES IN EMERGENCY
DEPARTMENT
Dr. Manal Elsayed Abdelaziz
B.Sc. Pharm, CPHQ, DTQM, CLSSGB,
TeamSTEPPS Master Trainer
2.
3. Definitions of “Quality”
The famous experts in the
subject define “quality” in the
following ways:
“Meeting of customers’ needs”
(W. Edwards Deming);
“Fitness for use” (J.M. Juran);
“Conformance to requirements”
(Philip B. Crosby).
4. Definitions of “Quality”
“degree of conformity
with accepted principles
and practices
(standards), the degree
of satisfying the
patient’s needs, and the
degree of attainment of
acceptable outcomes,
while making
appropriate use of
resources.” (JCI)
5. Efficiency:
It is one of the most important
key dimensions of quality.
It is the optimum utilization of
resources to produce the
desired outcomes.
6.
7.
8. Goals of Trying to Maximize
Patient Flow Efficiency in the E.D.
Improve patient care
Improve patient satisfaction with care
Lessen stress on E.D. staff
Limit financial costs to hospital
Allow more available staff time for
teaching
9. What Does Maximizing Patient
Flow in the E.D. Really Mean ?
Limiting as much as
possible the time
intervals between each
sequential event that is
necessary for patient
care
Maintaining quality,
safety, completeness,
empathy, and personal
attention in patient care
10. Fundamental Principles Behind
Improving Patient Flow Efficiency
Anything that delays evaluation by
the emergency physician is
detrimental
Everyone in the department must
be committed to & cooperative
with efficiency efforts
Provision of emergent care
procedures always takes
precedence
Making events simultaneous rather
than sequential increases
efficiency
11. Remember!
Maintaining efficiency
and speed are important
even when the E.D. is not
busy, because this
enables the E.D. to
better handle a sudden,
unexpected influx of
patients
12. Nursing Triage : Background
Aspects Related to Efficiency
Both CBAHI & JCI standards require that all
patients be medically evaluated prior to being
asked to register
Triage should take < 3 minutes maximum per
patient
Space & seating allowance necessary for multiple
simultaneous presenting patients
ER.8 There is an effective triage process to prioritize emergency
patients.
ER.8.1 There is a process to identify patients with urgent or
emergent care needs.
ER.8.2 Patients with urgent or emergent needs are given priority for
assessment and appropriate and
timely care.
ER.8.3 Re-triage is performed when appropriate (e.g., change of
medical condition, long waiting time).
13. What Exactly Constitutes Proper
Efficient Nursing Triage ?
Immediate "experienced eyeball"
assessment of the patient's
condition
"One line" chief complaint
Vital signs :
o Pulse
o BP
o Resp. rate
o Temp.
Current meds & allergies
14. Patient Disposition Options
for the Triage Nurse
Take patient immediately back
to emergency care area
Send patient to E.D. registration
Send patient to a "non-
emergent" care area
Send patient to X-ray or
laboratory prior to being sent
into E.D.
o By preapproved written protocol
based on chief complaint
15. Time-Saving Techniques at
Registration
If others accompany the
patient, have them register the
patient while triage and initial
E.D. care are started
Automatically obtain patient's
recent E.D. chart to
accompany current chart
16. Standard Efficiency Criteria
for Initial Patient Care
For any potentially unstable patient,
nursing should go ahead with O2 (2
L/min.), monitor, IV, blood draw, ECG,
pulse oximetry, & early ER Physician
notification
X-ray +/- resp. techs may need to be
notified & activated, but ER Physician
should see patient prior to their
actions
ER Physician should be notified of
priority of multiple simultaneous
patients
17. Patient Evaluation Efficiency
Techniques for Physicians
For several near-simultaneous
patients :
oSee 1 or 2 simple cases only
requiring exam or single x-ray
first, then see a more
complex or involved patient,
then recheck the x-ray
results for the simple cases
while awaiting lab, etc. for
the complex case
oHold data completion till after
all these patients are seen
18. Draw & send lab tests early if
needed
o Pelvic & secondary exams should
be done after lab is sent
o Hold split urine specimen + extra
blood tubes in case secondary
tests prove needed
Complete entire physical
exam prior to ordering X-rays
so all films can be done at
once
Patient Evaluation Efficiency
Techniques for Physicians
19. Patient Evaluation Efficiency
Techniques for Physicians
Lengthy non-resuscitative
procedures on patients who are
definitely going to be admitted
anyway should not delay evaluation
& disposition of patients with simple
or more minor problems
Verify specific times that labs were
sent to know when to check up on
them
Once a stable case is turned over to
a consultant, don't hover over the
patient
20. Suturing Efficiency Techniques
for E.D. Physicians
Have equipment obtained &
set up while you are doing
the H&P
Don't X-ray the wound for
foreign bodies if you can
explore it directly
adequately
Have staff obtain discharge
meds & instructions while
suturing is being done
21. Charting Efficiency Techniques
for E.D. Physicians
Dictate/Write charts
whenever free time is
available
o May split dictation (dictate initial
H&P first ; then later add
addendum dictation once lab &
disposition are known)
Leave charts in the locations
where they're supposed to be so
time is not wasted tracking them
down
22. Interactive Efficiency
Techniques for E.D. Staff
Don't be rigid about job duty
performance
o Helping someone else with their job
may speed things up a lot
o Extra attention should be directed
to help the person who is the most
busy
Let E.D. staff know your patient
care plans so they can
anticipate further actions
Have flexible room coverage
assignments
23. Improving E.D. Patient Flow
Efficiency : Summary
All E.D. staff should take interest
& pride in efficient patient flow
Anticipation and cooperation are
key
"Mapping out" of short term
events is helpful in planning
System should be geared to
minimize time to initial ER
Physician exam. & to make
events simultaneous rather than
sequential