1. Problem statement:
• The average time at St. Vincent Williamsport Hospital for emergency department (ED) disposition to inpatient admission is 94 minutes.
• Definition of disposition time: a measurement of the time when the physician admits the patient from the ED until the patient is taken to IP unit
Background:
• Prolonged disposition times and ED crowding compromises care quality, increases costs, and compromises community trust. Furthermore, ED
crowding will be measured by Centers for Medicare & Medicaid Services (CMS) under the Hospital Inpatient Quality Reporting Program initiative.
By improving patient flow hospital-wide, this problem can be improved (McHugh, Van Dyke, McClelland, & Moss, 2011).
• The desired level of performance is 60 minutes or less.
• Due to the prolonged disposition wait time, the following have occurred:
• Intergroup hostility between units has increased
• A delay in patient care has developedHCAHPS scores have decreased
• Current score of 54.8%
• Target score of ≥70%
• There has likely been a loss in revenue to the ED.
• According to Pines, Batt, Hilton, and Terwiesch, “A 1-hour
reduction in ED boarding time would result in $9,693 to $13,298
of additional daily revenue from capturing left without being
seen and diverted ambulance patients” (2010, p. 331).
Recommendations
• Inpatient RN should always be the one to transfer the patient from the ED
• Inpatient RN ensures PRN orders are obtained from ED physician during
patient handoff in the ED
• Inpatient RN will pick up patient from ED within 30 minutes of bed
assignment confirmation
• If inpatient RN does not get patient within 30 minutes then ED RN will
transfer patient to inpatient unit
Deliverables
• SAINT Handoff Reporting Tool
• Time Data Collection Tool
• Bed Placement Checklist