Patient Flow Highway: Getting Your Patient Into The Fast Lane To Exit!

Purpose:
ED overcrowding has lead to delays in patient care,patient leave without being seen,patient elopements,ED diversions,& overall staff & patient dissatisfaction. In response, we developed & delivered strategies leading to remarkable results in providing high quality care while maximizing efficiency.

Significance:
In January 2005, the Joint Commission implemented a new leadership standard, "Managing Patient Flow", which mandates that hospitals develop and implement plans to identify and mitigate impediments to efficient patient flow throughout the hospital.

Strategy and Implementation:
Strategies included regenerated the ED Fast Track program & implemented bedside registration & a "right back" system allowing patients to be placed in an available bed in the ED, until all open beds are filled, regardless of arriving patient complaint; creatively on boarded physicians with various methods; waiting room greeter; implemented an ED Flow Coordinator to do daily rounds with the physicians on the patients' plan of care, conduct daily team huddles with ED nursing teams, collaborate with admitting teams to expedite a speedy admission, attend daily in-house bed meetings, assist in calling report on patients admitted to the hospital, complete inpatient paperwork, & work with the house flow coordinator & ED charge RN to maintain patient flow through the ED. Instituted a Direct Admit Area for immediate nursing eval of incoming patients into the admissions lobby area to be directly admitted by their physicians to ensure accurate placement of patients on appropriate inpatient units.

Evaluation:
From 2008 to 2011 YTD data is: Left without being seen went from 12% to 4%. Diversion hours dropped 1114.25 to 0. Door to bed time (Direct Admit Area) went from 150min to 60min. Admission holds ≥ 12hrs dropped from 14% to 5%. 90 Minute Turn Around Time (2010-2011) dropped from 107min to 83min.

Implications for Practice:
Delivering high quality care to patients is our top priority. Staff worked to improve capacity management to provide care to all potential patients. We've proven others can improve their front-end pressure points & implement strategies to shrink ED overcrowding to ultimately improve patient flow.