Implementing a ride share program for patient transportation home from a hospital admission.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 243-243
Author(s):  
Erin Lightheart ◽  
Colleen Kucharczuk
Keyword(s):  
Patient Flow ◽  
Gastrointestinal Surgery ◽  
Electronic System ◽  
Large Hospital ◽  
Improvement Project ◽  
Lengths Of Stay ◽  
Multidisciplinary Group ◽  
Additional Capacity ◽  
Transportation Program ◽  
The Coordinator

243 Background: This quality improvement project takes place within a large hospital, on a team that manages about 1700 oncology discharges per year. The hospital emphasizes the importance of discharging patients early in the day to encourage more efficient patient flow. On advanced medicine units within the hospital, 19% of discharge delays were reported as stemming from transportation issues related to family being delayed. Methods: A multidisciplinary group utilized a ride share company to implement a HIPPA compliant transportation program. Upon admission, each patient was screened for potential transportation barriers by a coordinator. Patients outside of a 35-mile drive from the hospital were excluded. Patients who expressed a concern about reliable transportation were offered enrollment. The patient completed a consent form, agreeing to be texted by the company with logistical information about their ride. At the end of the patient’s stay, the coordinator scheduled a “will call” ride within the vendor’s electronic system, which could then be activated by the patient via phone upon discharge. The coordinator tracked each patient’s barriers along with an estimated number of hours saved. Results: The average time saved per patient was 5.3 hours and, at peak, the average number of rides per month was 36. The estimated additional capacity created was 7.2 patients annually. About 14% of transportation barrier screenings resulted in a ride being scheduled. Of the patients that declined, 53% preferred to travel with family or friends, 28% were excluded due to distance, 10% were too ill to utilize the service, and 8% declined for other reasons. Conclusions: The intervention provided clear value to the institution and the patient, and the organization is now exploring a system-wide ride share transportation program. The team identified an untapped opportunity in using the program for admissions. Suggested patient populations for expansion include patients leaving the Emergency Department, those with fairly predictable lengths of stay, such as gastrointestinal surgery patients, and populations of relatively lower acuity since they are more likely to be well enough to get into their home without assistance. [Table: see text]

627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S169-S169
Author(s):  
Lisa M Shostrand ◽  
Brett C Hartman ◽  
Belinda Frazee ◽  
Dawn Daniels ◽  
Madeline Zieger
Keyword(s):  
Emergency Department ◽  
Gap Analysis ◽  
Burn Patients ◽  
Improvement Project ◽  
Burn Trauma ◽  
Charge Nurse ◽  
Lengths Of Stay ◽  
Burn Unit ◽  
Set Up ◽  
Trauma Activation

Abstract Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

scholarly journals Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anqi Chen ◽  
Scott Fielding ◽  
X. Joan Hu ◽  
Patrick McLane ◽  
Andrew McRae ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Flow Characteristics ◽  
Initial Assessment ◽  
Cox Models ◽  
Lengths Of Stay ◽  
Random Samples ◽  
High System ◽  
And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

scholarly journals Changing inpatient diabetes care in a district general hospital

2019 ◽  
Vol 19 (1) ◽  
pp. 49-52
Author(s):  
Marie Wallner ◽  
Basharat Andrabi ◽  
David Russell-Jones ◽  
Roselle Herring
Keyword(s):  
Length Of Stay ◽  
General Hospital ◽  
Patient Flow ◽  
District General Hospital ◽  
Model Of Care ◽  
Lengths Of Stay ◽  
Inpatient Diabetes ◽  
Time Period ◽  
Service Redesign ◽  
Evidence Based Care

Introduction: People with diabetes in hospital have longer lengths of stay and are at higher risk of experiencing avoidable harm. This has a significant impact on patient flow and capacity in any hospital Trust.Aims and Methods: A Trust-wide peripatetic inpatient diabetes service redesign was performed to deliver reduced medication errors, improved patient flow, reduced length of stay and reduced inpatient risk. The service redesign was delivered without new recurring expenditure on senior staff. The model of care was multidisciplinary and introduced consensus and evidence-based care with clear governance processes.Results: Following introduction of the new service on 7 December 2017 to 1 June 2018, a reduction in length of stay in both medicine and surgical divisions was seen with 2,168 ‘saved’ inpatient bed days compared with the same time period in the preceding year, which represented a significant cost saving for the Trust and improvement in patient flow. This was associated with a reduction in the number of diabetes-related Datix reports and serious untoward incidents.Conclusions: This is the first major diabetes service redesign in a small district general hospital. The introduction of a dedicated inpatient diabetes service has led to Trust-wide improvements in patient care and patient flow without additional cost to the Trust.

799 Free Transportation for Socioeconomically Disadvantaged Burn Patients: Quality Improvement Project

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S236-S236
Author(s):  
Laura Perez ◽  
Rebecca Castro ◽  
Steven E Wolf ◽  
Jong Lee
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Access To Care ◽  
Low Socioeconomic Status ◽  
Emergency Department Visits ◽  
Quality Improvement Project ◽  
Burn Patients ◽  
Socioeconomically Disadvantaged ◽  
Improvement Project ◽  
Transportation Program

Abstract Introduction Our Burn Center provides care to persons living in southeast area of our State. Patients residing in this area sometimes have low socioeconomic status (SES), and are often unable to return to burn clinic for continued care due to transportation barriers. Typically driving distance is over 80 miles involving ferry access, taking two or more hours each way. The aim of this quality improvement project was to examine the feasibility of a free transportation program for low SES patients who have barriers to transportation. Methods Our first step was to assess transportation needs. We started with a patient survey in clinic to determine if patients would be interested in free transportation and if the service would increase access to care. Survey with six questions was used to assess needs. Results We surveyed ten patients during burn clinic to determine if transportation would increase access to care. Nine patients responded positively and found transportation would be beneficial. One responded that he would not use it as he would use clinic appointment as opportunity to vacation in the area. Funding was secured from our School of Medicine. Community transportation providers were contacted and pricing was obtained. Transportation van was contracted with existing vender. Transportation is now available to patients with burn clinic appointments. We hope to expand to other clinics in the hospital in the future. The Transportation program will assist patients with access to care, compliance, decrease non-emergent Emergency Department visits and 30-day readmissions. Conclusions Transportation assistance for socioeconomically disadvantaged burn patients to follow up in clinic is needed. Nine out of ten patients surveyed were willing to use free transportation. We obtained funding to start a free transportation program once a month. This project began in October 2019. We have begun a once-a-month transportation assistance service to determine ridership and continued need. Twice monthly assistance may be needed and will be assessed over time. Our goal is ultimately to expand the program to include other clinics. Applicability of Research to Practice Free transportation program can assist patients with access to care, compliance, and decrease non-emergent Emergency Department visits and 30-day readmissions.

Reducing radiotherapy delays after surgery for breast cancer in five radiotherapy departments

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17011-17011
Author(s):  
S. P. Woynar ◽  
P. Burban ◽  
E. Le Prisé ◽  
P. Romestaing ◽  
C. Maylin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Patient Flow ◽  
Action Plan ◽  
Conservative Surgery ◽  
Breast Cancers ◽  
Ministry Of Health ◽  
Improvement Project ◽  
Treatment Processes ◽  
Breast Cancer Radiotherapy

17011 Background: An interval superior to 8 weeks between surgery and radiotherapy increases the risk of recurrence for patients with early stage breast cancer treated with conservative surgery and breast irradiation and without chemotherapy. Five French radiotherapy departments launched simultaneously a quality improvement project aimed at reducing the delay to radiotherapy for all types of cancers concerned. Breast cancer radiotherapy delays were used as the principal proxy to evaluate overall progress. Methods: Teams focused their efforts on reducing the interval between the first appointment with the radio-oncologist and the start of the radiotherapy, interval on which they had control. Between May and December 2005, consultancy firms financed by the Ministry of Health, helped the teams (radio-oncologists, physicists, radiographers and nurses) to realize an organizational audit: identifying the processes of treatment, analysing the patient flow and the staff and equipment capacity. Concerning breast cancer, target intervals were set based on the 8 weeks standard. An action plan that included matching capacity and demand (better allocation of staff time during the week), standardising treatment processes and patient programming was implemented between January and December 2006. Results: The five radiotherapy departments reduced the delays to radiotherapy for breast cancers as well as for the majority of the other cancer types. Concerning breast cancer, the average of the five departments intervals between the first appointments and the start of the radiotherapy dropped from 4.9 weeks to 2.3 weeks, reducing in the same time the interval between surgery and radiotherapy. Furthermore, the teams’ cohesion, motivation and sense of responsibility increased, key elements for the sustainability of the improvements. These results were obtained without an increase of the departments resources. Conclusion: By redesigning their organisation with a patient centred goal, the five radiotherapy departments were able to meet the standards of practice. Following these results, ten new departments have joined the program financed by the Ministry of Health. No significant financial relationships to disclose.

scholarly journals Outcomes of patients with systolic heart failure presenting with sepsis to the emergency department of a tertiary hospital: a retrospective chart review study from Lebanon

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022185 ◽  
Author(s):  
Gilbert Abou Dagher ◽  
Karim Hajjar ◽  
Christopher Khoury ◽  
Nadine El Hajj ◽  
Mohammad Kanso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Hospital Mortality ◽  
Descriptive Analysis ◽  
Systolic Heart Failure ◽  
Retrospective Chart Review ◽  
Electronic System ◽  
Tertiary Hospital ◽  
Lengths Of Stay ◽  
Secondary Outcomes

ObjectivesPatients with congestive heart failure (CHF) may be at a higher risk of mortality from sepsis than patients without CHF due to insufficient cardiovascular reserves during systemic infections. The aim of this study is to compare sepsis-related mortality between CHF and no CHF in patients presenting to a tertiary medical centre.DesignA single-centre, retrospective, cohort study.SettingConducted in an academic emergency department (ED) between January 2010 and January 2015. Patients’ charts were queried via the hospital’s electronic system. Patients with a diagnosis of sepsis were included. Descriptive analysis was performed on the demographics, characteristics and outcomes of patients with sepsis of the study population.ParticipantsA total of 174 patients, of which 87 (50%) were patients with CHF.Primary and secondary outcomesThe primary outcome of the study was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) and hospital lengths of stay, and differences in interventions between the two groups.ResultsPatients with CHF had a higher in-hospital mortality (57.5% vs 34.5%). Patients with sepsis and CHF had higher odds of death compared with the control population (OR 2.45; 95% CI 1.22 to 4.88). Secondary analyses showed that patients with CHF had lower instances of bacteraemia on presentation to the ED (31.8% vs 46.4%). They had less intravenous fluid requirements in first 24 hours (2.75±2.28 L vs 3.67±2.82 L, p =0.038), had a higher rate of intubation in the ED (24.2% vs 10.6%, p=0.025) and required more dobutamine in the first 24 hours (16.1% vs 1.1%, p<0.001). ED length of stay was found to be lower in patients with CHF (15.12±24.45 hours vs 18.17±26.13 hours, p=0.418) and they were more likely to be admitted to the ICU (59.8% vs 48.8%, p=0.149).ConclusionPatients with sepsis and CHF experienced an increased hospital mortality compared with patients without CHF.

scholarly journals Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Assaad Sayah ◽  
Loni Rogers ◽  
Karthik Devarajan ◽  
Lisa Kingsley-Rocker ◽  
Luis F. Lobon
Keyword(s):  
Positive Impact ◽  
Patient Flow ◽  
Waiting Times ◽  
Improvement Project ◽  
Ambulance Diversion ◽  
Experience Of Care ◽  
Left Without Being Seen ◽  
Patient Satisfaction Scores ◽  
Core Measures ◽  
The Impact

We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS) dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.

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