ED Accreditation Update: Get your ED patients in, out with ‘virtual’ beds
ED Accreditation Update
Get your ED patients in, out with virtual’ beds
Mary Washington Hospital is trying out a "virtual bed system" that, when compared to the controls, decreased the average time to triage by 39%, decreased the turnaround time for treat and released patients by 16%, and decreased door to physician times by 82%.
The system was developed by two physicians, including Jody Crane, MD, MBA, assistant director and business director of the Fredericksburg (VA) Emergency Medical Alliance, a private contract emergency medicine group at Mary Washington.
It involves having all a patient’s testing conducted upfront so a patient is never waiting for anything except discharge, Crane says. The patient initially is seen and evaluated by a physician/nurse team who determines the patient’s needs, he says.
"Pain is addressed immediately, and any orders which need to be processed are done right behind triage," Crane says. Immediate orders include EKGs; medications such as those for asthma, pain, or allergies; urine specimens; splints; and even contrast for computed tomographies. The labs are processed by a phlebotomist and ED tech team behind the triage area. "From there, if the patient has X-rays, they are escorted to our radiology room about 20 feet away where their radiographs are performed," Crane says.
Afterward, if they are clinically stable, they are placed in the "Results Waiting" area. "This is actually one-half of the ED waiting room sectioned off and equipped with a 42-inch plasma screen," Crane says. "In this area, patients are constantly updated as to their status by an information board on the plasma screen referenced by their pager number and by patient service reps who constantly circulate around the area assisting patients."
When all of the test results are back, patients are whisked to a room, seen by a second provider, their documentation is completed, their results are reviewed, and in many instances, they are discharged without the physician or physician assistant ever leaving the room, Crane says. "A discharge nurse comes and processes the discharge, and the patient leaves satisfied," he says.
This system has undergone three trials, and the results have been very good, Crane says. For example, because of the integrated chest pain process, most stable chest pain patients will have their EKG done and read by a physician, hemoglobin and hematocrit and troponin drawn and completed, and their chest X-ray completed and visible on the digitalized radiography system before the patient goes to a room, he says. "We have had several instances where a chest pain patient was seen by the ED physician, [primary physician] was phoned from the room, and admission placed without leaving the room in around 40 minutes," Crane says. The current average for their facility under the traditional system is three hours and three minutes.
"We have also had complex workups in stable patients with painful problems who were treated for their pain up front and, by the time their results were back, their pain had resolved and they were discharged," he says. "In our current system, these patients likely would not even have been evaluated in that time frame, or if they had, they would need to restart the clock’ in order to give the pain meds time to work once they were ordered by the ED physician."
More importantly about the trial, 95% of patients rated their ED experience "good" or "excellent," and 75% stated that their wait was shorter that expected, "which we all know is unusual to hear," Crane says.
At press time, he hoped to implement the system by this winter, but it will require adding a few more nurses, techs, and patient service representatives to interact with the patients waiting on results, he says. Additionally, the hospital is exploring the medical/legal issues of having a physician in triage, which shifts risk from the system to the physician, Crane says.
Mary Washington Hospital is trying out a virtual bed system that, when compared to the controls, decreased the average time to triage by 39%, decreased the turnaround time for treat and released patients by 16%, and decreased door to physician times by 82%.Subscribe Now for Access
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