scholarly journals Improving Emergency Department Throughput: Using a Pull Method of Patient Flow

2021 ◽  
Author(s):  
◽  
Jeffrey Collins
Keyword(s):  
Emergency Department ◽  
Delay Time ◽  
Medical Center ◽  
Patient Flow ◽  
Length Of Hospital Stay ◽  
Hand Off ◽  
Practice Problem ◽  
Inpatient Units ◽  
Push Model ◽  
Surgical Unit

Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies. PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation? Evidence: A total of 21 studies were identified in the literature that directly support the implementation of this project. Themes from the literature include delays adversely impact patients, ED throughput is directly affected by throughput of inpatient units, and bed ahead programs can improve throughput. Intervention: The primary intervention for this project was implementing a bed ahead process for the host facility. The nurse hand-off process was also altered to improve efficiency. Outcome: The project resulted in an improvement in the ED delay time. During the project, the mean admission delay time was reduced from 184 minutes to 112 minutes. Conclusion: Using a pull methodology effectively enhances ED throughput by reducing delays in the ED admission process.

scholarly journals A modular simulation study to improve patient flow to inpatient units in the emergency department

2014 ◽  
Vol 3 (6) ◽  
pp. 205 ◽  
Author(s):  
Shaghayegh Norouzzadeh ◽  
Joseph Garber ◽  
Melonie Longacre ◽  
Salaahuddin Akbar ◽  
Nancy Riebling ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cycle Time ◽  
Patient Flow ◽  
Discrete Event ◽  
Wait Time ◽  
Process Improvements ◽  
Ed Overcrowding ◽  
Current Resource ◽  
Inpatient Units ◽  
Modular Simulation

In this study, a modular discrete event simulation (computer modeling) has been presented to support process improvements in a hospital’s emergency department (ED) to streamline admitted patient flow to inpatient units. Because the ED in this study has less than 10 beds, unnecessary occupation of beds affects the patient wait time dramatically. Additionally, ED overcrowding diminishes the quality of care, increases costs, and decreases employee and patient satisfaction. The modular simulation model evaluated the effectiveness of several recommended workflow improvements, resulting from comprehensive statistical analysis, based on their impact on cycle time and time traps in the process. The results suggested that, to ensure better efficiency and optimal cycle time, all of the suggested workflow improvements should be implemented simultaneously. The model also suggested that achieving customer satisfaction is possible 96.26% of the time with the current resource allocations in the ED.

scholarly journals (A122) Using Focused Operations Management Tools to Analyze and Alleviate Emergency Department Overcrowding

2011 ◽  
Vol 26 (S1) ◽  
pp. s34-s35 ◽  
Author(s):  
D. Schwartz ◽  
B. Ronen ◽  
J.S. Pliskin ◽  
A. Goldberg
Keyword(s):  
Emergency Department ◽  
Operations Management ◽  
Medical Center ◽  
Patient Flow ◽  
Care Quality ◽  
Patient Comfort ◽  
Electronic Patient Records ◽  
Affecting Factors ◽  
Emergency Department Overcrowding ◽  
The Impact

IntroductionEmergency department overcrowding plagues departments worldwide with grave implications on patient comfort and care quality. Many standard approaches have been introduced without widespread success. A new approach is required. Focused Operations Management (FM) integrates novel managerial theories and practical tools into a systematic approach to complex systems, promoting insight and improving performance. It has allowed systems in the industry and service sectors to radically improve throughput and quality with no or little additional cost. The implementation of the FM in the emergency department setting to alleviate overcrowding has never been attempted, and it could revolutionize emergency department operations management.MethodsEmergency department patient flow data affecting factors and outcomes from a large tertiary medical center, exclusively utilizing electronic patient records, will be collected. Root causes and influencing variables of emergency department overcrowding will be mapped and analyzed using FM tools. Later, alleviating measures will be developed and evaluated. During phase two, data will be collected from two additional emergency departments, measuring the impact of implementation of FM operational changes on emergency department flow parameters such as length of stay, wait times, clinical outcomes, and patient and staff satisfaction.ResultsData collection and analysis of phase one of the study will be completed by March 2011 and presented at the conference. The authors speculate that the FM tools will allow better understanding of the root causes and affecting variables of emergency department overcrowding and help plan and later implement efficient interventions.DiscussionThe implementation of the novel management strategies of FM has revolutionized operations in many industries and services, helping them to drastically improve performance. The emergency department is a perfect candidate for the use of these tools, due to the overwhelming current operational difficulties (with overcrowding as a prominent symptom) and its complex high volume and high acuity patient flow.

scholarly journals The Impact of a Concierge Medicine Model on Door to Doctor Time and Patient Flow in an Urban Emergency Department

2020 ◽  
Vol Volume 12 ◽  
pp. 13-18
Author(s):  
Asher L Mandel ◽  
Thomas Bove ◽  
Amisha D Parekh ◽  
Paris Datillo ◽  
Joseph Bove Jr ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
The Impact ◽  
Urban Emergency Department

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

scholarly journals The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

2021 ◽  
pp. 084456212110144
Author(s):  
Behdin Nowrouzi-Kia ◽  
Mary T. Fox ◽  
Souraya Sidani ◽  
Sherry Dahlke ◽  
Deborah Tregunno
Keyword(s):  
Emergency Department ◽  
Role Conflict ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Medical Unit ◽  
Scale Scores ◽  
Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

scholarly journals Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review

Heliyon ◽  
2021 ◽  
Vol 7 (4) ◽  
pp. e06626
Author(s):  
Paulina Cecula ◽  
Jiakun Yu ◽  
Fatema Mustansir Dawoodbhoy ◽  
Jack Delaney ◽  
Joseph Tan ◽  
...  
Keyword(s):  
Mental Health ◽  
Artificial Intelligence ◽  
Literature Review ◽  
Patient Flow ◽  
Narrative Literature ◽  
Narrative Literature Review ◽  
Inpatient Units ◽  
Improve Patient

scholarly journals 688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
L Hoggett ◽  
A Bhutta
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Prospective Data ◽  
Fracture Clinic ◽  
Face To Face ◽  
Return Rates ◽  
Acute Hospitals ◽  
Virtual Fracture Clinic ◽  
Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

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