Strategies to Address Shortage Rural Healthcare Workers

Several strategies can be used to address the shortage of healthcare workers in rural communities.

Financial Incentives

Offering financial incentives such as loan forgiveness, sign-on bonuses, and salary increases can help attract healthcare workers to rural areas. Governments, healthcare organizations, and community groups can provide these incentives to healthcare workers who agree to work in rural areas.

Training and Education

Training and education opportunities for healthcare workers already in rural areas can help improve their skills and knowledge. Healthcare organizations can provide regular training and continuing education programs for their staff to keep them up to date on the latest medical advances.

Telemedicine

Telemedicine can help bridge the gap in healthcare services by connecting rural communities with healthcare professionals who are not physically present. It allows patients to receive medical care remotely, reducing the need for in-person visits and, therefore, more healthcare workers.

Partnership and Collaboration

Establishing partnerships between healthcare organizations, academic institutions, and community groups can help support the developing and retaining healthcare workers in rural areas. For example, academic institutions can partner with rural healthcare organizations to provide clinical training opportunities for their students in rural healthcare settings.

Community-Based Programs

Community-based programs such as community health workers and outreach programs can provide basic healthcare services to rural residents, reducing the demand for healthcare workers. These programs can also help improve health literacy and raise awareness of healthcare issues in rural communities.

By implementing these strategies, rural communities can improve their ability to attract, train, and retain healthcare workers, and provide better access to healthcare services for their residents.


Critical Access Hospitals differ from Sole Community Hospitals

Sole Community Hospitals (SCHs) and Critical Access Hospitals (CAHs) are rural hospitals, but they have some key differences in their eligibility criteria, reimbursement rates, and regulations. Here are some of the main differences between SCHs and CAHs:

Eligibility criteria:

SCHs are located in rural areas and are the only hospital within a specified geographic area. They typically have fewer than 50 beds and serve as the primary source of inpatient care for residents in the surrounding community. CAHs, on the other hand, must be located in a rural area more than 35 miles from another hospital or inaccessible by secondary roads. They typically have fewer than 25 beds and must meet certain other criteria to be eligible for reimbursement under the Medicare program.

Reimbursement rates:

SCHs are eligible for Medicare reimbursement at a higher rate than other rural hospitals. This increased reimbursement can help SCHs cover the costs of providing essential healthcare services to their communities. CAHs are also eligible for higher Medicare reimbursement rates, but the reimbursement rate for CAHs differs from that of SCHs.

Regulations:

SCHs are not required to be designated as such by any federal agency. However, they must meet certain eligibility criteria to participate in the 340B program. CAHs, on the other hand, are designated by the Centers for Medicare & Medicaid Services (CMS) and must meet certain criteria to be eligible for reimbursement under the Medicare program. They are also subject to other regulations and requirements related to patient care, quality improvement, and other areas.

Size:

SCHs typically have fewer than 50 beds, while CAHs typically have fewer than 25 beds. Regardless both types of hospitals may provide various services, including emergency, primary, and specialty care.

Location:

SCHs are typically the only hospital within a specific geographic area and serve as the primary source of inpatient care for residents in the surrounding community. CAHs must be located in a rural area more than 35 miles from another hospital or inaccessible by secondary roads.

While both Sole Community Hospitals and Critical Access Hospitals are critical in providing healthcare services to rural communities, they have some key differences in their eligibility criteria, reimbursement rates, and regulations. It is important for healthcare providers to carefully consider each option's benefits and drawbacks before deciding which designation to pursue.

Do Return ED Visits Signal Lower Quality of Care?

This week, I’m revisiting a blog post from the summer that discusses whether or not return visits to the ED are an appropriate metric to consider when measuring quality of care. While one may think that return visits to the ED are a good indicator of hospital performance, a recent study from the Journal of the American Medical Association offers evidence to the contrary. 

When a patient makes a return visit to the emergency department, you may draw the conclusion that quality of care the first time wasn’t great. But a study recently published in the Journal of the American Medical Association offers data that may contend otherwise.

The study’s authors acknowledge that return visits to the ED “are increasingly monitored as a hospital performance measure and have been proposed as a measure of the quality of emergency care.” So they set out to find whether or not these return visits, which led to in-patient admission, were evidence of a lower quality of care from the ED that initially treated the patient. The pervading question being, if a patient is ultimately admitted to the hospital, shouldn’t it occur during their first visit to the ED and not the second or third?

Researchers looked at in-hospital mortality, intensive care unit admission, length of stay, and inpatient costs to determine whether a patient returning to the ED was a reliable measure of quality of care within that ED. The results were surprising.

“Compared with adult patients who were hospitalized during the index ED visit and did not have a return visit to the ED, patients who were initially discharged during an ED visit and admitted during a return visit to the ED had lower in-hospital mortality, ICU admission rates, and in-hospital costs and longer lengths of stay,” researchers concluded. “These findings suggest that hospital admissions associated with return visits to the ED may not adequately capture deficits in the quality of care delivered during an ED visit.”

Let’s look closely at the numbers. Patients discharged from an ED and subsequently admitted to the hospital upon a return visit experienced:

  • An in-hospital mortality rate of 1.85 percent vs. 2.48 percent for those patients admitted during their initial visit to the ED.

  • An ICU admission rate of nearly 6 percent less (23.3 percent vs 29 percent).

  • The cost of care for these patients was also less ($10,169 vs. $10,799), even though their length of stay was slightly higher (5.16 days vs. 4.97 days).

And for those patients admitted to the hospital within 14 and 30 days of their ED visit? Similar outcomes were experienced. 

But what about those patients readmitted to the hospital after hospital discharge and a return visit to the ED?

“In contrast, patients who returned to the ED after hospital discharge and were readmitted had higher rates of in-hospital mortality and ICU admission, longer lengths of stay, and higher costs during the repeat hospital admission compared with those admitted to the hospital during the index ED visit without a return ED visit,” researchers found.

What do you think? Are return visits to the ED an adequate measure of quality of care? Please comment below, or feel free to drop me a line.

SOURCES:

The Journal of the American Medical Association: “In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department”

How an Improved Patient Flow Process Makes Your ED Safer

An optimized patient flow process offers several benefits for the emergency department. For example, efficient patient flow allows EDs to manage increased patient volume and throughput. It also reduces the costs incurred by EDs as a result of extended lengths of stay and boarding. EDs with an established and sound patient flow process experience higher staff morale and increased levels of patient satisfaction. Most importantly, improving patient flow increases patient safety in the emergency department, which is critical for ED and hospital leaders focused on patient experience.

We can all agree that emergency department crowding is, by and large, the greatest threat to patient safety. I discussed this correlation in a recent blog post, but I wanted to take some time to talk more about how an optimized patient flow process counters overcrowding and will lead to improved safety in the emergency department.

For patients experiencing life-threatening conditions— such as strokes, heart attacks and trauma — time is of the essence. Staff also must be able to have the confidence that bottlenecks or barriers to care do not appear when treating patients with these conditions. Inefficiencies in the ED may place undue stress on nurses, physicians and support and result in increased workloads, all of which pose a threat to patient safety. But when an optimized patient flow process is in place, ED and hospital leaders can be assured their patients will receive complete, comprehensive care without a risk to staff morale and patient safety.  

ED leaders must also understand the effects of bottlenecks and barriers to care in the ED can put a strain on other areas of the hospital, such as inpatient units. Rapidly admitting patients to inpatient units does little good if no beds are available. Efficiency isn’t really about the speed in which an ED admits, discharges or transfers a patient. It’s about providing quality care that’s appropriate while effectively managing the expectations of patients and their families along with relevant staff stationed throughout the hospital. If the ED is the front door of the hospital, it’s also where the flow of patients begins and the foundation for a culture of patient safety.

Delivering quality care promptly within the ED isn’t the only factor that contributes to this culture of patient safety. Effective communication and teamwork is also critical to patient safety and patient flow. Miscommunication takes an immense toll on an ED’s tally of preventable medical errors. If you’re an ED or hospital leader who has made the wise decision to revamp an inefficient patient flow process, make sure your communication strategy is tailored to the new plan. Communication is especially important during the implementation of any new or updated plan, no matter the performance areas you’re focusing on. Open-door policies, standardized communication practices and deep analysis of existing and potential communication structures are all proven strategies to increase patient safety and improve patient flow.

Need help improving your ED’s patient flow? Schedule a complimentary phone consultation with Connie Donovan to discuss what’s happening in your ED.

SOURCES:

Agency for Healthcare Research and Quality: “Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals”

Agency for Healthcare Research and Quality: Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Emergency Department Overcrowding and Patient Safety

The correlation between emergency department crowding and a decline in patient safety is strong. Studies even suggest the risk to patients is twice as great during times of peak traffic, making interventions all the more necessary, considering the consequences to the patient experience.

Despite this study and a few others, there’s a severe shortage of research that reports on the relationship between crowding and patient safety.

In this article published in the Annals of Emergency Medicine, Jesse M. Pines, MD, MBA acknowledges that “the first reports of crowding in US EDs emerged in the late 1980s and early 1990s. Now, more than 20 years later, the first published claims-based, US-based, health services research report links what may seem to an everyday person to be an obviously unsafe environment to negative patient outcomes.” (This study the author alludes to found that patients had a 5-percent higher chance of death if they were admitted on days with increased crowding, along with longer stays, and higher costs per admission.)

Then the author makes another critical observation regarding how the very term, “ED crowding,” is outdated because “one of the main causes of ED crowding is ‘hospital crowding’ and its result: prolonged boarding of admitted patients in the ED.”

So what actions can ED and hospital leaders take to reduce crowding? I’ve written extensively about ways to combat overcrowding by optimizing patient flow and improving communication inside the ED and between departments. Real-time analytics is another important tool that can be used to reduce crowding and shows increasing promise. But the solution many EDs turn to — and, admittedly, the umbrella the tactics mentioned above fall under — is actually adaptation. To put it simply,  for EDs to continue providing high quality care safely and efficiently, they have to adapt to an ever-increasing volume of patients.

Adapting to crowded ED environments and developing ways to work with less than desirable circumstances isn’t discussed very often, as Pines’ article from the Annals of Emergency Medicine points out.

“Another unspoken issue in the relationship between ED and hospital crowding and quality outcomes is that some EDs may have actually adapted to the inhospitable crowded environment and have created safer mechanisms to deal with the dysfunction,” the article states. “These may include adding nurses or techs to the triage area, using point-of-care testing to identify high-risk patients (i.e., troponin or lactate), or creating hospital policies that ensure that patients who are likely to be harmed by crowding (such as boarders) are rapidly evaluated and cared for by inpatient teams in the ED.”

However, just like the dearth of research regarding overcrowding and patient safety, there’s also a lack of discussion regarding the adaptive responses EDs take in response to crowding, which place ED and hospital leaders in a difficult situation — fixing a problem that is ill-defined and understudied, even though the impact is obvious.  

So the question still remains, how do ED leaders, emergency care providers and other stakeholders fix a problem that is so ill-defined and understudied? The case can be made for further studies, specifically of hospitals that have successfully adapted to crowding and those that haven’t.  

How has your ED adapted to increasing patient volumes? Have you successfully reduced crowding in your ED, or are you still working to develop and implement customized solutions? Share what has and hasn’t worked, or feel free to drop me a line to share your experience.

SOURCES:

Internal and Emergency Medicine: “Emergency department crowding and risk of preventable medical errors.”

Annals of Emergency Medicine: Emergency Department Crowding in California: A Silent Killer?

Annals of Emergency Medicine: Effect of Emergency Department Crowding on Outcomes of Admitted Patients

How to Effectively Transfer Patients From the ED to an Inpatient Unit

An optimized patient flow process is critical to effectively transfer patients from the emergency department to an inpatient unit. Often, it’s not the patients in the waiting room that weigh heavily on an ED’s resources and signal an issue with crowding; it’s the number of patients waiting to be admitted to the hospital from the ED.

It’s not always easy as an ED leader to effect change in another department such as an inpatient unit. But it is important to work in tandem with other hospital leaders and administration to improve the patient experience for all patients whether they’re discharged straight from the ED or require more long-term care as an admitted patient. While the ED often functions as the front door to the hospital, it’s much more than an entryway — it’s a place where great care and treatment begins. High quality of care must continue in a safe and timely way as patients are transferred out of the ED.

Here are a few steps ED leaders can take to reduce the time needed to transfer patients from the emergency department to an inpatient bed.

Reduce your nurses’ patient loads.

This story from the Institute for Healthcare Improvement offers a great example of how implementing a few changes, such as improving the patient load of your nurses, can help reduce the amount of time it takes to transfer ED patients to an inpatient bed.

How did they do it? The patient flow team at Lee Memorial Hospital in Fort Myers, Florida, led by Linda Biittner, R.N., reduced their nurses’ patient loads from four patients to three patients per nurse. By reducing the nurse-to-patient ratio, nurses were far more productive, and patients were discharged faster. This “counterintuitive” strategy also proved critical to reducing transfer time by 80 percent.

Keep an eye on your metrics.

The flow team at Lee Memorial also implemented a computer-based system to track how long admitted patients had been waiting in the ED. According to Biittner, the system allowed her to have a better understanding of how patients were flowing through the ED, allowing her the opportunity to know how long patients were waiting and how much time doctors were spending with each patient.

Create a line of inter-department communication.

Opening a different line of inter-department communication was another tactic Biittner employed to help reduce the amount of time it took to transfer patients from the ED to an inpatient bed. When these changes were implemented back in 2004, ED staff replaced lengthy phone calls to inpatient units with faxes. Additionally, a bed turnaround team was created to ensure beds were ready for patients upon arrival, and bed turnaround time was reduced by more than 15 minutes.

But what happens if there are no inpatient beds available?

Don’t board them in the hallways of the ED, board them in inpatient hallways. Thisstudy from the Annals of Emergency Medicine provides evidence that admitted patients prefer to be boarded in inpatient hallways as opposed to the ED. There’s a direct correlation between ED boarding and overcrowding, so if ED and hospital leaders are able to move patients to an inpatient unit, even if no bed is available, patients are more likely to express higher levels of satisfaction, and ED crowding will be reduced.

Has your emergency department successfully reduced the amount of time it takes to transfer patients from the ED to an inpatient bed? Comment below, or feel free to drop me a line to share your experience.

SOURCES:

Institute for Healthcare Improvement: “Reducing Transfer Time from the Emergency Department to Inpatient Bed: Lee Memorial Hospital”

Annals of Emergency Medicine: “27 Patients Prefer Boarding in Inpatient Hallways: Correlation With the National Emergency Department Overcrowding Score (NEDOCS)”

How an Interim Management Consultant Adds Value to a Hospital and its ED

Emergency departments are complex care delivery systems with many interdependent components such as medical and support staff, inpatient and ancillary services and the community they serve.

CEOs, CNOs, COOs and CFOs rely on ED leadership and management teams to ensure clinical operations are aligned with quality and patient safety initiatives, value-based reimbursements and patient experience demands. And even though your emergency department may have great managers and directors on staff, it may need to be energized with temporary assistance. 

Working with an ED interim management consultant can help engage your current leadership team and bolster internal resources with additional experience and talent. ED interim management consultants are experienced emergency department leaders with deep clinical operational, financial and regulatory-accreditation experience. They support existing hospital management and leadership, providing clinical processes and tools to optimize what is working well. They also identify inefficiencies in the ED and then develop and implement practical, customized solutions to combat them. 

Whether it’s for one week or three months, the benefits and practical knowledge these consultants bring to the emergency department are immense. Here are a few ways interim management consultants add value to a hospital and its emergency department.

Improved clinical operational performance and patient experience.

Interim management consultants establish a strong foundation within your ED to strengthen clinical operations for value-based reimbursement. By focusing on staffing and scheduling effectiveness, as well as patient flow, they can improve clinical operations and heighten patient experience. Interim management consultants will also develop and implement a comprehensive and sustainable improvement plan and build upon current strategies to craft long-term improvements.

Stability.

At times your hospital may have an ED management vacancy, which may result in unnecessary disruptions. By filling the vacancy with an interim management consultant, ED leaders can ensure continued progress on any initiatives and reduce the likelihood of any communication breakdowns. They can ensure that new, incoming managers are brought up to speed while providing stability to existing ED staff. They’ll also engage your team and openly communicate goals, actions, timelines and milestones.  

Time. 

It’s important to act fast when filling an open leadership position, but finding the right person takes time. Interim management consultants allow you to devote more time and energy to finding the perfect permanent replacement. 

A fresh perspective.

Interim management consultants are often able to identify problems or issues that have previously gone undetected in an emergency department. The fresh pair of eyes interim management consultants lend to EDs can quickly spot inefficiencies in the patient flow process and any issues that could cause harm to patient safety initiatives. And, drawing from their vast experience in the field, they will be able to develop and implement innovative and creative solutions promptly.

Experience and solutions.

Even the highest-rated EDs have room for improvement, whether it’s a leaving without being seen rate that’s slightly above the national average or a bottleneck in the patient flow process that results in an unnecessary increase in lengths of stay. The best interim management consultants seek ways to strengthen these areas in the emergency department, maintaining high expectations when it comes to quality of care, patient satisfaction and patient safety – always ensuring that goals are aligned with their client’s business and patient care objectives. To do this, they draw from their wealth of experience to improve the quality of care EDs provide. 

When your current staff and leadership need a boost, or you experience a vacancy in your leadership team, interim management consultants like myself can help sustain the infrastructure of your emergency department while continuing to improve the patient experience. Donovan and Partners always keeps patient quality and safety in mind when working with emergency departments no matter their needs and the amount of time we spend with them. That’s why we work hand in hand with existing leadership to make transitions seamless and ensure operations continue to run smoothly, even when leadership positions are in question.

4 Signs That Your Emergency Department Isn’t Properly Staffed

This week I’m revisiting a blog post from the summer related to the importance of proper staffing in the emergency department. Staffing isn’t just about having enough support on the floor at a given time — the best staffing procedures take into account the strengths and weaknesses of each team member with focus on patient safety and satisfaction, maximum efficiency and cost-effectiveness. If you’re a hospital or ED leader questioning whether your emergency department is properly staffed, this post identifies four key indicators to help you determine if staffing issues are present.

 

Proper staffing is an important component of emergency department efficiency. EDs that aren’t appropriately staffed may find it difficult to provide the high-quality and timely care patients seek and deserve.

Determining when and how to utilize your staff for maximum efficiency and cost effectiveness can prove challenging. Patient volume fluctuates and the effects can be difficult to predict even when taking historical data and real-time analytics into account. Additionally, the strengths and weaknesses of your staff must be considered when scheduling, as should the possibility of outside events beyond your control. When it comes to staffing, preparation is everything.

But how can ED leaders conclude whether or not their ED is properly staffed in the first place?

When working with EDs, I look at four indicators first to assess if staffing issues are present. These signs can be very telling when it comes to staffing and scheduling, and whether your team is being utilized in the most efficient and cost-effective manner.

1. Patient throughput time

The first place to look to determine whether or not your ED is properly staffed is your patient throughput times. If they are above the national or state averages, or are steadily rising from month to month, staffing issues may be the reason why.

Throughput times may increase for a variety of reasons, so it’s important to analyze other factors to determine which ones may be contributing to the rise. An increase could be related to an inefficient patient flow process; poor communication among staff and other departments; or a combination of factors that should be addressed with a tailored action plan.  

2. Leaving without out being seen (LWBS) rate

Just like high patient throughput times, increased LWBS rates are a key indicator that your ED isn’t properly staffed. Patients will leave if their concerns aren’t addressed in a timely manner. How your ED is staffed — specifically at triage — plays a crucial role in making sure all patients are seen.  

3. Patient satisfaction

If patient satisfaction scores are lower than expected, your schedule may be the reason why. While patient satisfaction scores aren’t the most telling of indicators when it comes to staffing issues your ED may be facing, they are important to consider. Communication and pain management are key drivers of patient satisfaction. However, staffing may be an underlying cause behind these and other issues leaving your patients unsatisfied. If staff is in a pinch for time, it can take longer for them to get patients the pain management solutions they need in a timely manner. And, a harried staff can make clear, empathetic communication challenging.

4. Staff morale

ED staff are under a considerable amount of stress even when an ED is appropriately staffed. If you notice that your turnover rate is on the rise or that there is a general sense of dissatisfaction among your staff, take a look at your schedule. Morale is closely related to the three indicators discussed above — patient satisfaction especially. If patients aren’t satisfied, your staff won’t be either. A solution may lie in a few tweaks to the staff schedule.

The most effective way to properly staff an ED is by first analyzing the strengths and weaknesses of your staff members and creating the schedule accordingly. Although, the natural inclination for many ED leaders facing issues related to staffing is to increase the number of staff on duty and on-call during a given shift. However, this strategy can be expensive and it doesn’t always address underlying issues like playing the right staff in the right positions.

If you believe your ED isn’t properly staffed, Donovan+Partners can assess the reasons why and create an action plan that maximizes efficiency while keeping your bottom line in mind. Contact Donovan+Partners today at connie@donovanpartners.com or 651-260-9918. I'd be happy to do a personalized assessment of your ED and provide actionable solutions. For more information on the services we offer, visit our website.

SOURCES:

Collins, Martha: “Staffing an ED Appropriately and Efficiently.”

https://www.acep.org/clinical---practice-management/staffing-an-ed-appropriately-and-efficiently/

3 Online Resources ED Leaders Can Use to Improve Patient Flow

Improving patient flow is one of the most important steps ED leaders can take to reduce crowding, boost patient and staff satisfaction and improve quality of care in the emergency department. A number of potential strategies, solutions and tactics exist — and experts and consultants like myself can aid in implementation.  However, developing a strong patient flow improvement plan can be daunting, especially in the initial stages.

Luckily, a number of online resources are available for those stakeholders interested in assessing their patient flow process and taking the steps necessary to make it more efficient.

Check out these three online resources ED leaders and staff can use to improve patient flow.  

George Washington University School of Medicine & Health Sciences | Urgent Matters

Urgent Matters describes itself as “a dissemination vehicle for strategies on emergency department (ED) patient flow and quality.” They’re a wealth of valuable information for ED and hospital leaders interested in improving patient flow. Urgent Matters develops and offers webinars, podcasts and a blog that cover timely issues related to emergency care. They also have a searchable toolkit stocked with case studies as well as strategies and solutions for common problems and concerns related to patient flow.  

ACEP | Emergency Medicine Crowding and Boarding

The American College of Emergency Physicians is a great resource for ED leaders investigating potential solutions related to the problems brought on by overcrowding and boarding. ACEP’s informative website is a must-visit for ED leaders, physicians and staff interested in improving patient flow.Admittedly, the information found on ACEP’s website may seem dated, but the material and examples available are still relevant and appropriate for EDs today, especially in regards to policy making, state legislation and advocacy. Additionally, ACEP provides access to lectures and seminars that address issues and best practices related to patient flow.

Institute for Healthcare Improvement

The Institute for Healthcare Improvement is another organization offering access to case studies, white papers and other resources on how to improve patient flow. IHI also features improvement tools that ED leaders may find useful such as ones to help track data related to patient flow.

While the sites mentioned above are just a few of the many online resources available that focus on improving patient flow, they’re  home to valuable information and resources related to patient satisfaction and quality of care. If you’re serious about improving the quality of care your patients receive and increasing satisfaction, patient flow is the first place to start. By implementing a few strategies to improve flow within your ED, you’ll see a positive impact when it comes to crowding, leaving without being seen rates and overall length of stay time, just to name a few benefits.

ED and hospital leaders: What online resources have you sought to help improve not just patient flow, but quality of care and satisfaction? Did you find them useful? Comment below or feel free to drop me a line to share your experiences.

Patient Safety: 2 Strategies to Battle Sepsis in the ED

In August, the Centers for Disease Control and Prevention released a study  that evaluated medical records of nearly 250 adults and almost 80 children from four New York hospitals. By uncovering common characteristics prevalent among patients with sepsis, the researchers hoped to better understand sepsis and identify strategies to prevent, recognize and treat this threat to patient safety. 

Emergency departments, already take sepsis very seriously. Strict protocols are in place to reduce transmission of pathogens that can lead to sepsis, and sepsis prevention is an important component of an ED’s overall patient safety strategy. But as the rate of sepsis cases continues to increase each year, EDs must revisit the protocols and programs they have in place to prevent this often fatal syndrome from affecting their patients.

Here are two strategies EDs can employ to prevent, reduce and better treat cases of sepsis within the ED.

1. Communicate With At-Risk Patients, Their Caregivers and ED Staff

Increasing awareness of sepsis among your patients and their caregivers is critical to preventing infection. Patients with risk factors for sepsis should be made aware of signs and symptoms. Though symptoms of sepsis often mimic other conditions, if a patient knows the warning signs, sepsis can be treated early and result in more positive outcomes.

Speaking with staff members is also vital to preventing and decreasing sepsis cases. Check in regularly to ensure ED staff are considering the risk factors associated with sepsis when assessing patients and are following established protocols to reduce transmission of pathogens within the ED.

2. Make Early Detection a Priority

Early detection of sepsis is critical for patient safety. Between 28 and 50 percent of the 1 million patients affected by sepsis each year die. If a patient presents with fever, increased heart rate and increased respiratory rate — and sepsis is the cause — early detection can be a matter of life and death. Work with your staff to develop a detailed sepsis plan for early detection in the ED, and reach out to other departments within the hospital to expedite treatment. Though the onset of nearly 80 percent of sepsis cases begins outside of the hospital and ED, many patients the CDC surveyed had visited a healthcare provider prior to infection.

CDC researchers from the study concluded, “While this likely reflects the vulnerability of chronically ill patients to infection, it also suggests that health care facilities and providers could play a central role in sepsis prevention by providing age-appropriate and condition-appropriate vaccination to all patients and optimizing the health status of patients with chronic conditions.”

Early diagnosis and treatment of sepsis in the ED can increase survival rates among patients. And for EDs, continued focus on reducing the transmission of pathogens will decrease cases of sepsis stemming from a patient’s interaction with the ED. Sepsis impacts emergency departments across the country, and being able to combat it effectively is critical to patient safety.  

What strategies has your ED implemented to prevent and reduce sepsis? Comment below, or feel free to drop me a line.

SOURCES:

Centers for Disease Control and Prevention: Vital Signs: Epidemiology of Sepsis: Prevalence of Health Care Factors and Opportunities for Prevention

National Institute of General Medical Sciences: “Sepsis Fact Sheet"

3 Strategies to Reduce Non-Urgent ED Visits

We know many patients presenting to emergency departments don’t necessarily need treatment there. Depending on the severity of a patient’s symptoms, quality care can be had in other, more appropriate settings such as a primary care physician’s office or urgent care. But redirecting patient traffic to these locations is often a challenge.

With more non-urgent visits come longer wait times, extended lengths of stay and decreased patient satisfaction within an ED. So, what can ED leaders do to reduce these non-urgent visits to their emergency departments?   

It’s important to first look at the data and determine the scope of the problem. Find out just how many, or the percentage of, patients each month visiting your ED could be treated elsewhere and identify the common causes of those visits. Once you determine the extent of the problem, only then can you begin to alleviate it.

These three tactics outlined below have proven to significantly reduce non-urgent visits to EDs. Hospital leaders will need to tailor a specific and strategic plan based on the issues their ED and community of patients are facing.  

1. Telephone Nurse Triage

Developing and implementing an in-house nurse triage system is one innovative way of reducing non-urgent ED visits. By offering patients 24/7 access to trained medical professionals via telephone, nurses can direct patients to quality care in the most appropriate setting based on their needs. 

Midland Memorial Hospital in Midland, TX, set up a telephone nurse triage system that employs a software-based algorithm to determine patient acuity. The system allowed nurses to direct patients suffering from non-urgent ailments to obtain the care they need in a more appropriate setting, while encouraging patients facing a serious condition to visit the ED. The result was a reduction in the number of patients present with non-urgent symptoms, which led to a decrease in LOS, wait times and leaving without being seen rates.

2. Real-time Video Consultation

Partnering with emergency medical services to provide real-time video assessments of patients outside the emergency department can also reduce the number of non-urgent visits.

When the City of Houston Fire Department implemented its own Emergency Telehealth and Navigation program (ETHAN), area EDs saw a decrease in unnecessary patient visits after ED-based physicians conducted video consultations with patients in the field. 

Once physicians via video determine that emergency care isn’t necessary for patients, the program takes the necessary steps to schedule and provide transportation for patients to a care partner — typically primary care medical homes — to provide continued treatment.

3. Collaboration

One key element or solution to curbing non-urgent ED visits is collaboration. It’s important to partners and stakeholders who can offer assistance and provide long-term care to specific high-frequency ED users such as individuals battling substance abuse and those experiencing homelessness. Without collaboration and teamwork, reducing non-urgent ED visits may be difficult. 

Has your ED successfully reduced the number of non-urgent ED visits? Or is it a problem your ED still faces? If so, feel free to comment below or drop me a line to share your experience.    

 

SOURCES:

Agency for Healthcare Research and Quality: “Telephone Nurse Triage System Reduces Use of Emergency Department by Nonurgent Patients, Reducing Wait Times, Length of Stay, and Patient Walkouts”

Agency for Healthcare Research and Quality: “On-the-Scene Video Consultations With Emergency Physicians Reduce Unnecessary Ambulance Transports and Emergency Department Visits, Connect People to Medical Homes”

3 Ways to Encourage Continuity of Care Among Patients in the ED

Nurse Checking Patient's Heartrate

Many patients visiting emergency departments suffer from chronic conditions. They’re often older adults battling various ailments that require long-term care, such as asthma, diabetes and heart disease. And often, they aren’t receiving the treatment necessary for sustained health. That only increases the likelihood that they’ll have to visit the ED again in the near future.

It’s important that ED staff can identify these people and help transition them to an appropriate care setting or treatment center at discharge. The odds that these same people will return to the ED are high if no long-term care plan is implemented.

Not only is that bad for the patient, it can have a negative impact on wait times, crowding, patient safety and patient satisfaction. By taking a proactive approach and encouraging continuity of care for ED patients suffering from chronic conditions, your emergency department will be able to counteract those effects.

So, what can EDs do to ensure patients with chronic conditions seek out and receive appropriate care upon discharge from the ED?

Plan for Discharge

First, make sure your ED has a strong discharge checklist in place that has specific instructions about:

  • medication and dosage
  • information about follow-up appointments

contact information for organizations and healthcare providers in the community that can help the patient develop and follow an overall care plan

Make sure your staff takes the time to carefully go over the discharge checklist with their patients, as well as their families and caregivers. By taking a few extra moments to answer any questions about the treatment plan, along with where and how to seek care outside the ED you’ll likely reduce the chances of a return visit to the ED. A referral to a primary care physician, community support group or treatment center may all be appropriate.

Carefully Assess Patients, Including for Chronic Conditions

Additionally, EDs must accept that their role in healthcare has evolved into something much more than providing emergency care. Patients, understandably, aren’t always able to determine whether they’re symptoms or conditions merit emergency medical attention, as this issue brief from the Kaiser Family Foundation points out. As a result, EDs are often making the clinical assessments patients need to begin long-term treatment.

While these diagnoses and assessments are a first step, they shouldn’t be the last step taken in the emergency department. As the issue brief makes clear, these assessments can no longer be deemed an inappropriate use of the ED by patients. It’s now the norm, especially in EDs serving vulnerable populations who may have limited access to primary care.a first step, they shouldn’t be the last step taken in the emergency department. As the issue brief makes clear, these assessments can no longer be deemed an inappropriate use of the ED by patients. It’s now the norm, especially in EDs serving vulnerable populations who may have limited access to primary care.

Identify Barriers to Care

EDs must utilize all the resources at their disposal to empower their patients to take action outside the ED. This will require EDs to identify the barriers preventing their patients from seeking long-term care. Short surveys during the triage process can be an effective means to determining what these barriers may be. Whether it’s limited access to transportation, financial restraints or a lack of knowledge regarding available care options, EDs can be help patients navigate the healthcare landscape to overcome these hurdles.

Recent studies show that continuity of care reduces the likelihood that patients will visit the ED, or make a return visit. The emergency department should serve as a jumping off point to continued care and better health for its patients. As a bonus you’ll reduce the effects of crowding, increase patient satisfaction and provide the highest quality of care possible.

What do you think? What can EDs do to encourage continuity of care outside the emergency department? Share your thoughts below or feel free to drop me a line.

 

SOURCES:

The American Journal of Nursing: “Transitional Care: Moving patients from one care setting to another.”

The Henry J. Kaiser Family Foundation: “Safety-Net Emergency Departments: A Look at Current Experiences and Challenges.”

Science Daily: “Seniors with more continuity of care use the ER less.”

How Great Emergency Nurses Impact Patient Experience

Emergency Nurse

It’s been quite a year for nurses working in emergency departments (EDs) across the country. From the opioid epidemic to the mental health crisis, emergency nurses have had to confront more than their fair share of difficulty. And they do it all while exceeding the high expectations placed upon them by the healthcare industry and the community in which they serve.

The responsibility faced by emergency nurses is immense. They not only have to perform lifesaving procedures on a daily basis, emergency nurses also have to ensure each patient that walks through the door has the best experience possible.

As we celebrate Emergency Nurses Week, it’s important for ED leaders to realize just how instrumental these team members are to the patient experience. How exactly do they do it?

Nurses Lower Stress While Juggling Multiple Patients

Especially noteworthy is how emergency nurses are able to make a positive impact on the lives of patients and their families during stressful times.

The ED isn’t a place most people enjoy or even plan to visit. Visits are often unexpected and can be a great cause of stress for patients and their loved ones. So for emergency nurses to be able to enhance the patient experience given these circumstances — also while caring for multiple patients suffering from varying conditions and all with different personalities and needs — says a lot about the skills theses nurses have at their disposal.  

They Are Master Communicators

For emergency nurses, the ability to communicate effectively is increasingly important and for many, the most important tool. It’s truly the key to a positive patient experience.Effective communication is much more than telling a patient what to do to regarding treatment. It’s being able to listen and connect with patients to understand their concerns, no matter how trivial, and to put them and their loved ones at ease as best one can. Empathy and compassion are important components of effective communication and are invaluable when it comes to making the ED experience one where patients are empowered to have a voice in their care.

Emergency Nurses Manage Expectations

Nurses also play a pivotal role when it comes to helping patients anticipate what to expect. Expectations that aren’t met or grounded in reality given the situation are likely to have a negative effect on a patient’s experience in the ED. This is especially true across the board in stressful situations.

Communication comes into play here again — nurses understand better than most what patients can expect during their visit. When they are able to relay this information in a kind and compassionate way, it will often counter the impact of an extended stay or crowded waiting room.

And for emergency nurses, managing expectations isn’t solely limited to those of the patient, they often play an important role in managing expectations of everyone who enters the ED, from family members to EMTs, all of which shape the patient experience.

In closing, emergency nurses deserve all the recognition and celebration that comes their way this week and beyond. This week should also be a reminder for ED leaders, doctors, patients and their families of just how critical emergency nurses are. They help to provide a positive experience for everyone who walks through the doors of an emergency department. What do you think are some of the qualities that make a great ED nurse? How are you celebrating Emergency Nurses Week? How do you recognize the nurses in your life? Share your ideas and plans below.

Do You Need a Patient Flow Coordinator in Your Emergency Department?

Two Nurses Meeting

It’s Emergency Nurses Week. Do you have someone filling the critical role in your ED? The role of the patient flow coordinator — or nurse — is to ensure patients receive the highest quality of healthcare in the timeliest manner. They do this two ways:

  • By streamlining the flow of patients through the emergency department from admission to discharge or transfer;
  • And by helping hospital staff, in and outside the ED, provide a level of care that exceeds expectations.

So, if patient flow coordinators are so vital to the quality of care and patient satisfaction, why aren’t they more common in the ED? Is it not worth the investment?

How Patient Flow Coordinators Can Improve Numbers

A 2012 research study published in the Journal of Emergency Nursing contends that the initial investments necessary to create these positions do pay off over time.

Researchers conducted their study at an urban academic medical center facing issues related to overcrowding within its ED. A “fast track” area was implemented, the size of the ED was increased, beds were placed in the hallway and ambulances were diverted. But only by assigning an emergency nurse as a flow coordinator to “affect patient throughput in the emergency department,” were researchers able to see a considerable decrease in patient length of stay, LWBS rate and monthly hospital diversion.

By the numbers:

  • Length of stay decreased by 87.6 minutes.
  • LWBS rate decreased by 1.5 percent.
  • Monthly hospital diversion decreased from 93 hours to 43.3 hours.

Patient Flow Coordinators Can Positively Impact Your Bottom Line

The researchers also remind us these decreases have a significant impact on a hospital finances:

  • Decreasing monthly hospital diversion by an average of 49.8 hours per month leads to a decrease of almost $20 million in lost potential charges annually.
  • By lowering the LWBS rate by 1.5 percent, nearly $5 million in lost potential charges are saved annually.

And of course, if length of stay can be decreased by nearly 90 minutes, patient satisfaction will surely increase.

Another example highlighting the benefits of patient flow nurses and coordinators is one out of Lexington, Kentucky.

Discharge Can Become a Priority

This article tells the story of Baptist Health Lexington COO and CNO Karen Hill, who created a patient flow nurse position when she realized her RNs weren’t consistently making patient discharge a top priority. Instead, they were focusing on those patients that were most unstable or had the highest acuity levels.

Hill tells Health Leaders Media, "I've seen a huge transition in my nursing career from high-acuity hospital focused care to, now, a focus on wellness across the care settings. As we've done that, one of the things that I've tried to do is to help develop a different way to look at hospital care."

By creating the discharge/flow nurse position at Baptist Health Lexington, Hill was not only able to improve quality metrics and transition care while lowering staff turnover, but patients were being discharged more efficiently, a decrease in readmission occurred along with an increase in patients’ levels of education regarding discharge.

The data makes it clear that patient flow nurses and coordinators are a valuable supplement to any ED. But creating these positions and integrating them within an already established ED dynamic and culture isn’t easy. Donovan and Partners can help you assess your ED and determine the best course of action when it comes to staffing your ED with patient flow coordinators. Contact us today.

 

Sources:

Health Leaders Media: “How Patient Flow Nurses Help Cut Readmissions”

Journal of Emergency Nursing: “Does an ED Flow Coordinator Improve Patient Throughput?”

New Patient Flow Strategies? What to Keep in Mind for Implementation

Nursing Team

Improving the patient flow process in your emergency department relies heavily on not only what strategies and solutions you choose to implement but also how you decide to implement them.

A strong correlation exists between efficacy and execution. A detailed patient flow implementation plan acknowledges potential challenges and barriers, includes a detailed timeline and offers flexibility. By having one in place, you’ll increase your odds of success.

While your new patient flow process — and the strategies and solutions you’ve decided upon to create it — may seem foolproof on paper, below are  a few things you should consider before, during and following implementation.

Start slow. 

Improving patient flow isn’t a sprint; it’s a marathon. Expect to tweak your plan and strategy during the implementation process and adjust accordingly. Also, give a strategy or solution time to take effect. Like the medication prescribed to patients, relief isn’t always immediate. It takes time, and significant impact may arrive only after another component of the plan has been enacted.  

Create a communication plan. 

Ensuring your plan’s success will be a team effort. From hospital administrators to ED support staff, getting their buy-in will be critical and will require effective communication between stakeholders. Before launch, develop a communication plan with your patient flow team that will enable you and your team to troubleshoot any issues or concerns as they arise and to make sure everyone is on the same page.

Whether you schedule a daily in-person huddle, weekly Skype session, conference call, email thread or group chat, make sure the lines of communication are open and that all of your team members have an opportunity to share their voice as you implement your plan.   

Be realistic. 

This may be the most important thought to consider when implementing new patient flow strategies. To effect change in the ED, you have to take into account what your resources are and how they will determine your results.

For example:

  • Figure out early on whether or not you have the budget to implement new strategies. You must also determine if the results of implementation will provide a positive return on investment for both your bottom line and the quality of care your ED delivers to patients.
  • Consider personnel resources. If your patient flow plan consists of developing or adding a new position — think patient flow navigator — do you have the money to make it happen? If not, will you be able to secure more funds? How long will it take? Also, determine whether or not your plan will require staff to learn new skills.     

Take time to reflect. 

When you carefully consider each component or strategy you plan to implement it will prepare you for any hiccups along the way. It can give you time to create buy-in among your teammates and opens the lines of communication between one another. Devoting ample time for pre-launch review and dialogue among staff will make improving patient flow that much easier.

What else should one consider when working to improve patient flow within the emergency department? Share your comments below or feel free to drop me a line with your experience.

 

SOURCE: Agency for Healthcare Research and Quality: “Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals.”

3 Ways to Identify At-Risk Patients in Your Emergency Department

Nurse having conversation with patient

Successfully identifying at-risk patients is a challenge facing many busy emergency departments today. These patients — who often suffer from substance abuse or mental health issues — need long-term care EDs aren’t equipped to offer. But in many instances, the treatment provided by emergency department staff and physicians is the only care at-risk patients receive, resulting in a revolving door of frequent ED use.

The first step to providing at-risk patients the care they need is to identify them as such. And for EDs looking to improve patient flow and reduce crowding, identifying at-risk patients is crucial. Connecting these patients with appropriate care providers in the community will lead to earlier diagnosis, ease access to treatment and increase the likelihood of a positive outcome for patients, all while reducing the odds of a return visit to the ED.   

Here are a few ways staff can identify and initiate care for at-risk patients presenting to the ED.

1) Conduct surveys. Short surveys, though simple in approach, are an effective way for EDs to identify at-risk patients. For example:

The ED at the University of Michigan Medical Center instructs patients — following an initial screening process to determine eligibility — to complete a five-question electronic survey to screen them for eating disorders. This survey has proven successful in identifying patients who screen positive for a potential eating disorder and found many of these patients to be frequent users of their ED. Once identified, proper treatment can begin and lessen the likelihood of a return visit by these patients.

2) Create a risk assessment tool. Risk assessment tools built into existing electronic medical record systems are a great example of how existing technology can help identify at-risk patients. The Denver Health Medical Center ED uses such a tool to gauge a patient’s risk of HIV to determine whether or not they should be tested.

“The tool covers three demographic and five behavioral risk factors, each of which is assigned a point value, with the cumulative score reflecting the patient's overall estimated level of risk,” a report published by the Agency for Healthcare Research and Quality states. “A triage nurse administers the tool during the patient intake process and documents responses in an electronic tracking system that calculates the score in real time.”

And if the patient’s score suggests a moderate to high risk of HIV, then rapid HIV testing is conducted followed by counseling and links to ongoing treatment.

3) Develop a safety plan for patients. For those patients at risk of suicide, veterans especially, it’s important for EDs to have a suicide assessment strategy and intervention plan in place. Many VA hospital-based EDs have these plans in place, though it’s equally important for other EDs to consider. When veterans or other patients are identified to be at risk for suicide but don’t require an immediate intervention, a safety plan can be developed to help patients overcome their thoughts of suicide along with assistance connecting to community resources to lower the risk of suicide.

Do you have similar plans in place to identify at-risk patients and initiate the care? If so, comment below to share your experience or feel free to drop me a line.  

 

SOURCES: Agency for Healthcare Research and Quality: “Emergency Department Uses Tool To Identify At-Risk Patients in Need of HIV Testing, Leading to Same Number of Newly Diagnosed Patients with Fewer Screening Tests.”

Agency for Healthcare Research and Quality: “Emergency Department Screening Identifies Many Patients With Possible Eating Disorders, Suggesting Potential to Facilitate Earlier Diagnosis and Connection to Treatment.”

Agency for Healthcare Research and Quality: “Emergency Departments Identify and Support Veterans at Risk of Suicide, Enhancing Their Access to Outpatient Mental Health Services.”

How Electronic Health Records Improve Patient Care in the ED

Administrative Nurse

The use of electronic health records (EHRs) in the emergency department can be a critical step in the process of improving overall patient care. EHRs are a great example of how embracing new technology can provide long-term benefit to patients and staff, despite the short-term woes that may present themselves during implementation and integration. (Some hospital leaders, ED physicians and staff have, rightfully so, been hesitant to switch over to EHRs because of these short-term challenges. Nonetheless, the positives appear to outweigh the negatives in regard to electronic health records.)

Let’s look at a few benefits of electronic health record systems and how using them can improve patient care in emergency departments.

Easy Access to Patient Information

Getting a patient’s vital medical information is quick and easy thanks to EHRs. All the information you need to provide quality care in a timely manner to your patients is available in one digital location. Important information such as past medical history, immunizations, lab data and medications are right at your fingertips. And most importantly, the frustration of trying to decipher another healthcare provider’s handwriting is no longer a worry.

Clinical Decision Support

Clinical decision support (CDS) systems can be integrated into EHR systems to help providers make decisions on patient treatments, prescriptions and overall patient care plans. So what is a CDS?

“Some functionalities of a CDS system include providing the latest information about a drug, cross-referencing a patient allergy to a medication, and alerts for drug interactions and other potential patient issues that are flagged by the computer,” cites a reportpublished in the Journal of Risk Management Healthcare Policy. “With the continuous growth of medical knowledge, each of these functionalities provides a means for care to be delivered in a much safer and more efficient manner.”

Computer Physician Order Entries

Thanks to computer physician order entry (CPOE) systems, medical errors stemming from illegible or incomplete drug and lab test orders can be reduced. CPOE systems combined with electronic health record and clinical decision systems harness the efficiencies of each to reduce the potential for error and provide patients more efficient and higher quality care.

Health Information Exchanges

Health information exchanges (HIE), which share patient information between providers, allow for a continuity of care that pen and paper are unable to provide.

“Over a lifetime, much data accumulates at a variety of different places, all of which are stored in silos,” researchers note. “Historically, providers rely on faxing or mailing each other pertinent information, which makes it difficult to access in “real time,” when and where it is needed. HIE facilitates the exchange of this information via EHRs, which can result in much more cost-effective and higher-quality care." Just as easy access to patient information within the ED can improve care, providing this ease of access across the spectrum of healthcare providers will have a ripple effect that positively impacts the industry as a whole.

But implementing EHRs in the ED is no easy task. It’s daunting to switch systems while still being expected to provide the same high quality of care your patients deserve and are accustomed to. The benefits of EHRs, however, are promising and have the potential to dramatically improve patient care within the emergency department while lowering costs across the board. As the long-term effects of EHR use are studied, improvements in the implementation and integration of this digital technology will surely follow.

How has your ED fared when it comes to utilizing electronic health records? What benefits are you seeing? Feel free to drop me a line or comment below

SOURCES: Journal of Risk Management Healthcare Policy: “Benefits and drawbacks of electronic health record systems.”

HealthIT.gov: “Benefits of Electronic Health Records (EHRs).”

How to Better Evaluate, Transfer and Admit Psychiatric Patients

Handholding Compassion

The extended boarding of psychiatric patients is an issue facing many emergency departments today. Appropriate and timely treatment alternatives aren’t always readily available. And as a result, patients are left to wait in EDs, occupying much-needed beds and increasing the hospital’s average length of stay (LOS).

In most instances, psychiatric patients don’t require the services an ED is equipped to provide. However, the closing of mental health and substance abuse facilities in states across the country result in fewer options for immediate care for patients suffering from psychiatric disorders. For many of these patients, the ED is nothing more than a waiting room.  

An account of how one ED in Maine — Maine Medical Center — was able to transform its evaluation, transfer and admission process for its psychiatric patients offers sound strategies many EDs can adopt for reducing overall length of stay for these patients.

The researchers, whose report was published by the Institute for Healthcare Improvement, had a simple goal: decrease the ED’s average LOS for psychiatric patients from 10 hours to 6 hours. Over the next year, they worked to identify strategies to meet their goal.

What did they do?

For starters, researchers looked at the data. They identified key measures to help guide the steps needed to be taken to decrease LOS among its psychiatric patients. For example, they looked at total psychiatric admissions by month and patients per month with an LOS greater than 12 hours. Researchers also looked at the LOS for psychiatric patients and non-psychiatric patients admitted to the hospital and the mean security hours of each admitted patient per month.

After evaluating the data, researchers decided upon, and implemented, these eight changes to Maine Medical Center’s evaluation, transfer and admission process of psychiatric patients:

  1. Streamline and standardize clinical information collected
  2. Establish targets for LOS
  3. Standardize patient assessment tools for outpatient and inpatient acute psychiatry
  4. Establish medical clearance standards and provided staff education
  5. Move pre-certification process from ED to receiving psychiatric units
  6. Re-engineer admission process at Spring Harbor Hospital (SHH), an affiliated psychiatric facility
  7. Create multigenerational unit at SHH to increase flexibility in patient placement
  8. Form dedicated admission teams at SHH

A key change for Maine Medical Center was to work with its affiliated psychiatric facility — Spring Harbor Hospital — to help streamline the transfer and admission process. They did this while also tackling internal security issues related to the use of restraint and seclusion of psychiatric patients. (This was necessary to heighten safety of both patient and staff.)

By implementing a few strategies while focusing on security, safety and teamwork, researchers witnessed dramatic results. LOS dropped from its peak of almost 18 hours to just over 6 hours, even though Maine Medical Center experienced a 37-percent increase in the number of psychiatric patients it saw. And with this decrease in LOS, came less need for security staff.

What can other EDs learn from the experience of Maine Medical Center? Researchers sum it up this way:

  • Include the right members on the interdisciplinary team.
  • When appropriately focused and coordinated, the interdisciplinary workteam can do much to streamline patient management and disposition processes.
  • Think openly. Broad-based and simultaneous revisions of care processes engender much more process improvement than sequential, more narrowly based efforts.
  • Are psychiatric patients presenting to your emergency department experiencing an increased length of stay? Donovan and Partners can assess your current processes to help expedite the evaluation, transfer and admission of psychiatric patients arriving at your ED. Feel free to drop me a line or message me directly.

SOURCE:

Institute for Healthcare Improvement: “Improvement Report: Reducing Length of Stay in the Emergency Department for Psychiatric Patients”

Using Nurse-Initiated Protocols to Improve Patient Flow

Listening to Hear Rate

Busy emergency departments looking to reduce crowding and improve patient flow may not have to look much further than nurse-initiated protocols, a study from the Annals of Emergency Medicine suggests. By allowing nurses to initiate diagnostic tests and provide treatment prior to the patient seeing a physician or nurse practitioner, EDs saw a significant reduction in ED length of stay (LOS) and improved patient flow. Could this type of effort help your ED?

The study, entitled A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department, looked at six nurse-initiated protocols implemented in an overcrowded ED. They then evaluated the effect these protocols had on LOS and times related to diagnostic testing, treatment and consultation.

And the results were promising. The study found that:

  • Nurse-initiated protocols resulted in an 186-minute decrease of the median time it took for patients presenting with pain or fever to receive acetaminophen.
  • A suspected hip fracture protocol resulted in median length of stay decrease of 224 minutes.
  • A protocol targeting pregnant women presenting with vaginal bleeding led to a median LOS decrease of 232 minutes.
  • The ED was able to cut the median time to troponin testing for patients presenting with suspected ischemic chest pain by 79 minutes.

The researchers concluded that “targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay.” That should motivate ED leaders to consider implementing their own set of nurse-initiated protocols, if they haven’t already.

Are there any nurse-initiated protocols your hospital has implemented to improve patient flow that others can benefit from? Which ways have you seen improvements? Are there certain conditions you feel are prime for these type of protocols and could see benefits?

When it comes to patient satisfaction and your hospital’s bottom line, improving patient flow is a smart place to start. If you’re an ED or hospital leader interested in learning more about nurse-initiated protocols and how they can help alleviate crowding in your ED, my company, Donovan+Partners can help. We can assess your current patient flow process and determine which protocols should be established to improve flow, while continuing to provide the highest quality of care for your patients with safety in mind. Please reach out. I love helping EDs maximize efficiency to improve patient care and would love to chat with you.

Also, in case you missed it, check out my blog from last week on one of the first steps in improving patient flow — improving the EMS-to-ED handoff. It covers four strategies you can implement to improve communication and as a result, patient well-being. Several of you also offered your suggestions for improving the handoff of patients from emergency services specialists to emergency department staff.

As a follow-up, how often does your emergency department staff and emergency services personnel exchange interdisciplinary feedback and talk about scope of practice between out-of-hospital and hospital-based providers? How do you go about sharing?

 

Source: Annals of Emergency Medicine: “A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department.”