READi: Rapid Emergency Admission to Destination Initiative, improving a patient's transfer from ED to the ward

Purpose:
READi aims to improve-Time: reduce ED LOS, access block; Nursing care: increase nursing hours; Management of ambulance patients: reduce bypass & delay off-stretcher times; Communication: improve clinical handover & relationships between wards and ED; Documentation: improved documentation compliance.

Significance:
The ED sees 46,000 patients/year with 36% admitted to hospital. With 41% of patients waiting >8 hours to be admitted this is a risk to patient safety and decreases patient satisfaction. Research has demonstrated that ED overcrowding is associated with increased in-hospital mortality at 10 days.

Strategy and Implementation:
Using lean-thinking the current state was mapped, patients ready for admission were tracked, staff were surveyed and documentation audited. After analysing the results the strategy was to have clinical unit nursing staff manage the admission of the patient instead of ED staff. Implementation included a marketing campaign to all staff. This included A3 posters, general media communication, screen savers, tours to ED, presenting at all staff forums leading up to the implementation. Development of 24-hour communication links for management of patients to be admitted. This included generic email address, designated hotline phone number. Education & training of staff involved. Development of a green line on the floor to act as a visual cue to direct staff to the collection point in ED. Development of checklists, workplace guidelines outlining roles and responsibilities of each member of the team. Finally the development of daily and weekly feedback loops and evaluation processes.

Evaluation:
The average time for a patient to leave ED once identified as ready to leave significantly improved by an average 32 mins (p=0.000). Documentation demonstrated improvement in most components including clinical documentation and patient property with significance from p=0.000-p=0.003.

Implications for Practice:
Readi has shown that streamlining systems to improve the journey of patients from ED to the clinical unit has significantly improved patient care and reduced risk of harm. It has fostered a whole of hospital approach to management of ED capacity and throughput of patients.