Patient Flow Solutions: 'No-wait' ED a five-year success
'No-wait' ED a five-year success
Wait time to see practitioner cut in half
A true test of the success of a process improvement initiative is whether the results can be sustained, and the ED at Hudson Valley Hospital Center in Cortlandt Manor, NY, has just celebrated the fifth anniversary of its "no wait" process. Most patients skip the waiting room entirely and go right to registration, and then to triage.
"We've cut the wait time to be seen by a practitioner by 50%," says Ron Nutovits, MD, FAAEM, chair of the ED. "Most patients are now triaged within five minutes and seen by a practitioner within 20. Within the first month, our rate of patients who left without being seen went from .7% to .33%, and our Press Ganey scores went to the mid-90s." Nuvovits says the 35,000-visit ED was also recognized by Press Ganey for its high staff satisfaction scores.
Maryanne Maffei, RN, MS, director of nursing, explains the process. "When the patient comes in, they sign in at the registration desk. We do a quick registration name and date of birth so we can give them a medical record number, and then they have a seat. Their name then appears on our computerized system, and the triage nurse takes them from the waiting room to the triage room." When triage is finished, the patient is taken immediately into the care area, where labs and X-rays can be ordered and treatment begun, Maffei says.
Nuvovits says, "It became a one-way system. Instead of coming in, registering, and going back to the waiting room, now they come in and the greeter gets them into our tracking system, alerts the triage nurse; they go to triage and come directly from triage to the main ED." The department has two triage areas, so patients can be treated simultaneously, he adds.
Maffei says, "We really focused on triage in training. If more than two people are in the waiting room, the staff will go there, bring them to a room, and triage them."
It was emphasized to staff that this change would benefit patient safety. "We needed to change the thought process of some of the nurses in the department, so they could see how much safer it was going to be to bring patients immediately into the department for treatment," says Maffei. (For more on how to work with your staff, see the story below.)
Eventually, this approach became "part of the norm," she says. In fact, Maffei shares, there's another hospital nearby that is trying to implement a similar approach. "They were discussing it with one of our nurses, and she told them, 'Don't worry, it's hard at the beginning, but you get used to it,'" she says. (The transition was also made easier through the use of simulations, which helped ensure that staffing levels matched demand fluctuation. See the story below.)
Source
For more information on reducing wait times, contact:
- Maryanne Maffei, RN, MS, Director of Nursing, Ron Nutovits, MD, FAAEM, Chairman of the ED, Hudson Valley Hospital Center, Cortlandt Manor, NY. Phone: (914) 734-3247.
Simulation helps plan staffing One of the keys to the success of the "no-wait" ED at Hudson Valley Hospital Center in Cortlandt Manor, NY, was the use of a "virtual ED" simulation model that allowed ED leaders to predict what the resulting performance times would be using different levels of ED physician and nurse staffing, according to Ron Nutovits, MD, FAAEM, chair of the ED. "We analyzed the data to see how many patients would come in at what time of day," Nutovits says. "It showed our staff that if they said 'hello' right away and got the process going, we avoided the negative impact of not only dealing with patients who were irate, but we would not have to explain to patients several times an hour that we'd see them as soon as we could." Eric Bachenheimer, MHSA, MBA, FACHE, director of ED Solutions, the ED consulting/advisory services firm that developed the "virtual ED," says, "We were also able to predict the number of walkouts, patient-to-nurse ratios, census, and waiting times for patients in the ED. The benefits of this were significant in that we were able to identify the optimal staffing level and be able to understand what type of performance we could expect from employing that approach." (For more information, contact Bachenheimer at [email protected].) |
Heed staff when making changes Instituting process changes can be a "culture shock" for your staff. That shock can be eased by adopting an empathetic attitude, says Maryanne Maffei, RN, MS, director of nursing in the ED at Hudson Valley Hospital Center in Cortlandt Manor, NY. "Listen to your staff and try to understand what they're going through," Maffei advises. "If there are little changes you can make that will help them to better adapt and still enable you to reach your goal, then do it." It's important to make your staff feel they have some control over the changes that are about to take place, she adds. For example, she says, recalls members of the staff were concerned that with the "no-wait" process instituted five years ago, they would become backed up in triage. "They requested that if the greeter saw there were more than two patients in the waiting room that the greeter would call the charge nurse to notify her," she says. "The charge nurse in turn would send another nurse to triage, which would ease some of the pressure the nurses felt." As this process was in line with the new direction and did not significantly change the overall process, Maffei explains, it was a change that could easily be made and make the staff members feel that they had some control. |
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