Study provides leverage with administrators
Study provides leverage with administrators
19% more nursing hours approved
A five-year time study performed at Olive View-University of California at Los Angeles (UCLA) Medical Center in Sylmar showed that delays had been decreasing steadily but suddenly started to increase again.
"That’s because there was a fiscal crisis in the county of Los Angeles, and clinics were closing. This increased our patient census in our ED," explains Demetrios Kyriacou, MD, PhD, assistant professor of medicine at the UCLA school of medicine, director of trauma care in the ED at Olive View-UCLA Medical Center, and the study’s principal investigator.
The time study provided hard evidence that the delays were worsening because of increased volume and staff cuts, says Kyriacou. "Because we had done the time studies, we were able to show that despite all our efforts to move patients through faster, this increase was slowing us down again," he reports.
The study revealed the negative impact of staff cutbacks. There was a major cutback in staffing in 1995, and at the same time, the facility had an increase in the number of patients coming through the ED. "During this period of time, we saw an increase in the total time from presentation to discharge," says Vena Ricketts, MD, FACEP, assistant chief of the department of emergency medicine at Olive View and professor of medicine at the UCLA school of medicine.
Adverse effect demonstrated
This evidence was key in obtaining needed resources. The researchers went to hospital administration and made a successful case in getting more resources for the ED, says Kyriacou. "We showed that increasing our census by closing clinics and taking away nurses was having an adverse affect. We made a case that if they wanted us to become more efficient, they would have to give us back those nurses."
The time study’s findings convinced administrators to add 19% more nursing hours and approve an expansion of the ED. Obtaining that approval was a direct result of the study, says Ricketts. "We showed them that when beds are filled, then there is a bottleneck, and we had the numbers to prove it," she says. "That weighed heavily on their decision."
Using time study data is much more effective than basing interventions on assumptions alone, says Ricketts. This study yielded objective data and a collective measurement of multiple pathways or steps, she points out. "It was more of a team effort to identify the source of a problem area," she explains. "We weren’t just looking at the ED, but also all support staff."
Time study data can provide much-needed leverage when negotiating with hospital administrators, stresses Kyriacou. "It’s a constant fight to get the resources you need. Documenting things only makes your argument much stronger."
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