Improving Emergency Department Access at Penticton Regional Hospital
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Improving Emergency Department Access at Penticton Regional Hospital



This presentation was delivered in session D3 of Quality Forum 2014 by:

This presentation was delivered in session D3 of Quality Forum 2014 by:

Anne Morgenstern
Manager, Emergency Department, Penticton Regional Hospital
Interior Health



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Improving Emergency Department Access at Penticton Regional Hospital Improving Emergency Department Access at Penticton Regional Hospital Presentation Transcript

  • From Access to Success in the Emergency Department Improving Access to the Emergency Department at Penticton Regional Hospital
  • Penticton and Area ∗ 32,000 residents in the City of Penticton ∗ In the summer the population doubles to 60,000 ∗ Penticton Regional Hospital serves 79,000 people in the Okanagan Similkameen Hospital District Footer 2 2/24/2014
  • Penticton Regional Hospital ∗ 137 beds ∗ Services: Orthopedic and General Surgery, Intensive Care, Medical, Obstetrics, Pediatrics, Neurology, Rehab ∗ Regularly107-116% over capacity Footer 3 2/24/2014
  • PRH Emergency ∗ 13 bed Emergency Department ∗ 24 hour physician coverage ∗ 32,500 visits per year ∗ 80-100 patients per day ∗ 100-130 patients per day in the summer ∗ Average wait time to see physician for CTAS 2, 3, 4 and 5’s: 65 minutes Footer 4 2/24/2014
  • What is the problem? Emergency Physicians brought concerns forward: 1. Department congested with admitted patients 2. Physicians ready to see waiting patients but no space to assess them Footer 5 2/24/2014
  • What to do? ∗ Decision by the Director of Acute Care Services to enter into a Continuous Quality Improvement project ∗ September 2012: Initial Access and Flow committee brought together ∗ Early 2013: Emergency Department working group brought together to process map the patients journey. ∗ Data was captured around time to physician assessment
  • What Did We Find? Time From Registration to Initial Physician Assessment 2011/2012 150 100 50 0 CTAS 2 CTAS 3 Time (Minutes) CTAS 4 CTAS Guideline CTAS 5
  • Are the Admitted Patients Really The Problem? ED Activity Profile – CTAS distribution 60% 50% 40% 30% 20% 10% 0% 2009/10 CTAS 2 CTAS 3 2010/11 CTAS 4 CTAS 5 2011/12 LWBS/Unspec 84% of patients that come through PRH ED are not admitted!
  • Let’s focus! To improve the acute care patient flow through the Emergency Department while maintaining quality of care, despite competing demands and constrained resources. BY Creating a care area designed to meet the needs of the lower acuity ambulatory patients that don’t need a bed, utilizing existing physical and staffing resources
  • Streaming: Project Objective “Implement a streaming model of care delineating 4 distinct care areas that patients may be assigned to immediately following triage with the goal of improving the time from registration to Emergency Physician assessment by December 2013”
  • Streaming: How it works Initial Triage    Trauma/ Resuscitation • CTAS Level 1s and 2s Quick triage Patient demographics Brief and focused history    Patient assessment Assign triage score Assign Patient Care Area Minor Treatment Acute ED Stretchers • CTAS Level 2s and 3s • Patients that are not independently mobile • CTAS Level 4s and 5s • Lacerations • Cut fingers • Sprained ankles 11 Streaming • CTAS Level 3, 4 5 medical • Patients that are independently mobile
  • Streaming - How it Works ∗ 14 chairs and 4 exam spaces available for Streaming and Minor treatment ∗ Patients triaged to the chair area must independently mobile ∗ Patients who are too ill or too frail to sit in a chair are not appropriate for Streaming ∗ Streaming runs similar to a Physicians office or clinic ∗ Patients on stretcher only when receiving care from RN or MD ∗ Patients may walk to diagnostic imaging and back once studies have been ordered 12
  • Why Stream? ∗ More efficient use of minimal space 14 patients can be seen out of three stretcher spaces ∗ Decreased time waiting for a stretcher bay decreases wait to see the physician increasing patient satisfaction: Patients come to see the Dr. ∗ Improved time to diagnostic/treatment orders ∗ Patients are more willing to come back if condition worsens due to decreased wait time ∗ Number of people Leaving Without Being Seen decreases ∗ Mitigates the worries of leaving a sick person in the waiting room out of sight and un-assessed, increasing staff satisfaction ∗ Recruitment and retention is enhanced
  • Streaming as a care area Program Design ∗ ∗ ∗ ∗ ∗ Inclusion/exclusion criteria Physical space allocation Patient flow Staffing Model Equipment needs 14 24/02/2014
  • Creating Buy In One Month Education Blitz ∗ Mandatory one hour education sessions for all ED staff ∗ Education sessions for physicians ∗ Presentations to support services DI, Lab, Nursing Supervisors, Registration 15 24/02/2014
  • Go Live! APRIL 15th, 2013 Went live with Streaming Trial ∗ Daily Evaluations ∗ Daily communication reports and status updates ∗ Revisions, revisions, revisions!!!! Footer 16 2/24/2014
  • Challenge: Culture Shift How do we go from this…. Footer To this? 17 2/24/2014
  • Challenge: Concerns About Patient Dignity
  • Challenge: Who will change the sheets? Footer 19 2/24/2014
  • Challenge: Staffing Model ∗ Need to remove one RN on days to dedicate to streaming ∗ Team nursing model cherished ∗ How to cover breaks ∗ Staff mix Footer 20 2/24/2014
  • How Did We Do?? 140 Pre and Post Streaming Time to Physician Assessment 120 100 80 Pre Project Benchmark Post Project 60 Time saved 40 20 0 CTAS 2 Footer CTAS 3 CTAS 4 21 CTAS 5 2/24/2014
  • Wait times CTAS 2, 3, 4, 5 Pre Streaming Average wait to see the physician 65 42 Minutes Footer Post Streaming Average wait to see the physician Minutes 22 2/24/2014
  • Staff Satisfaction! ∗ “ As a PCC I don’t feel that constant worry about where I am going to put the next chest pain” ∗ “I love streaming…they’re in, they’re out, just like that!” ∗ “I can’t see how we would be functioning now if it was not for streaming.” When the team was asked recently by an administrator what they were most proud of as a team they said: STREAMING!!! Footer 23 2/24/2014