Laptops and pagers slash ED wait time
Laptops and pagers slash ED wait time
Registration moved to middle of visit
A change in the registration cycle, combined with the creative use of laptop computers and pagers, has halved the average time patients spend in the emergency department (ED) at St. Mary’s Health Center in Richmond Heights, MO.
In July 1995, the average length of stay (LOS) for a patient seeking treatment in the ED was three hours, 40 minutes. Now, LOS as measured by the time from when the patient enters the ED, is treated, and leaves, either to be admitted or to go home is one hour, 45 minutes, says Marianne Fournie, RN, patient care manager.
An ED quality improvement team examined the entire process of "getting in and getting out" and identified several key solutions, including the following:
• Working around technology.
A new hospitalwide computer system that requires 17 screens to register a patient meant that it would take 20 minutes to get a patient to a treatment room, even if there were no other delays, Fournie explains. The hospital plans to change that process, but can’t do it right away. So, to speed up things immediately, St. Mary’s moved registration from the beginning of a patient’s stay to sometime during the stay for patients who otherwise could be sent back for treatment.
"If there’s a delay to get back [to a treatment room], we do the entire registration up front," she says. "If not, we just get the basics name, address, phone number, Social Security number, doctor, and diagnosis. That initiates the chart in the system and is all we need to get the ball rolling," Fournie says.
Sometime during the patient’s visit, staff catch up on the registration, Fournie explains. They try to do this during rather than after treatment to avoid the risk of the patient leaving before the process is complete, she adds. Magnets on a flow board indicate a completed registration. The ED also purchased a laptop computer that allows staff to register the patients at bedside.
Handling registration later in the process also prevents patients from mistakenly thinking as some did that because registrars asked for insurance information, they would be treated only if they had insurance, Fournie says.
• Fix the worst first.
The team took the area with the longest delays and the highest volume of admits the telemetry floor and instituted a new procedure. Instead of calling reservations to arrange for a bed, registrars page the charge nurse directly, keying in a brief description of the patient "43-year-old male," for example.
The charge nurse, having already designated a nurse to receive that patient, calls ED personnel and gives them the patient’s bed assignment. ED registrars then tell reservations personnel where the patient is going. The new procedure reduced the number of phone calls involved from six to one, Fournie notes.
"The floor has total control over where a patient is placed they really like that," she says. "They know more than just a name."
The new procedure is more of a team approach, in line with the facility’s commitment to patient-focused care, Fournie adds. Her registrars also serve as unit clerks, floating between the ED registration area and patient units as needed.
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