Lean in Healthcare: Teachable Moment: Improving Patient Flow in the Emergency Department


Lean in Healthcare: Teachable Moment: Improving Patient Flow in the Emergency Department



this teachable moment is brought to you by the Jewish Health Care Foundation and the Pittsburgh Regional Health Initiative with the goal of reducing door to room and door to physician x and patient elopements learn how a team from st. Clair Hospital tackled these issues we knew that there was a problem and we could we it was very clear and very easy to identify dissatisfied patients long waiting times numerous patients leaving without even seeing a physician and a very frustrated staff a patient would arrive at the front door of the emergency department then they would typically have a seat in the waiting room they would fill out a piece of paper with their name and some basic identifications and a reason why they were here then they would have a seat in the waiting room they would then call the patient back to a triage room at that point they would get a full nursing assessment done and once that paperwork was completed they were typically asked to have a seat back in the waiting room the patient would then be asked to go to the Registrar in their office was down the hallway they would complete a registration process and be asked to have a seat in the waiting room again their paperwork would then go back to the back it would be put into a queue and that patient would then be waiting in the waiting room until they were called to the back and then the charge nurse would take them back and put them in the room typically they waited for the physician to come to the room make an assessment and then put orders into the system or let the nurse know that there was nice to meet you sorry you're not feeling so good prior to our changes or process improvement changes it could take upwards of eighty minutes before patient would even see a physician the specific tools we used utilizing the perfecting patient care principles started with a process map okay we've got most of our current condition worked out but I want to go back to that first moment and make sure we get all the steps right we actually walked the walk of the patient to truly understand what the current condition was after we understood the current condition we then could look for areas of opportunity now when a patient arrives they approach the intake nurse at that point the intake nurse identifies the patient an armband is generated immediately simultaneously while getting the patient's weight which is something we put in the system immediately so that if we have to give a critical medication we've got an accurate weight it's very important for patient safety the intake nurse or the intake tech will notice that there's a new patient that's going to a certain room and then that cascades down through the different staff members that are in the back and they respond back to the intake nurse Kirke available so that they know that there will be somebody there to greet the patient at that point the patient is taken directly to a treatment room in the back the nurse will mark that they're in the process of doing a triage assessment the nurse then changes the status of the patient to provider to see status which gives a blue flag indicator to our physician staff that they now have a patient that's ready to be seen the physician then we'll use that same status board and change the status of the patient from provider to see which was the blue flag to treatment in progress currently if we see one or two patients in our waiting room the entire staff gets nervous process improvement it's basically essential to any businesses operation prior to our improvement our door to room time averaged 54 minutes after our improvement we had that down to 18 minutes our Gorda physician time was 81 minutes we got it down to 40 minutes our patience believing without being seen averaged about a hundred and thirty a month after our improvement changes we were 15 in April of this year we went to the 95th percentile or the top 5% patient satisfaction and it looks like very soon we're going to be changing that sign to be the top one percent compassion satisfaction national

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