1. Emergency Department (ED)
Dealing with the SOS-challenge in an ED
October 2 2013
Healthcare Denmark
Michael Hansen-Nord, M.D. Head of Department
Odense University Hospital

2. 10.000 m2
January 2012
The largest ED-laboratory
in Scandinavia

3. Patients in ED, OUH
Categories
Triage (admittance?)
(2/3 of all)
Somatic fast-track
Emergency services
(7 hours daily)
Patients/year
(average)
25.000
40.000
60.000
125.000
(340/day)

4. S O S – challenge

Sickness rate
−
> 10 %
Overcrowding
 Stress
Dealing with those
challenges will optimize
the patients stay.


5. Standardization
1.
Processes
2.
Flow and logistics
3.
Diagnostics

6. Cut down to 3 different tracks
Emergency
service.
Admittance?
Fast track
Blue patients

7. The challenge…!
1.
4 hours in the diagnostic area to diagnosis.
1.
2.
14 – 18 staff members needed
> 75 % of the patients are yellow or green in
triage
1.
2.
They do not need immediate action
…but they should be kept in flow also

8. Admittance ?
Time pr. process
Total minutes in the acute area
Registration
Previsitation
In bed
Triage and visitation
Blood-analysis
Radiology
Waiting area
Senior doctors evaluation
Patients file
Stafet
Initial nursing
Minutes
Location
Staff … competences
5
5
15
20
15
15
1
1
2
2
2
3
Secretary
Nurse
Nurse
Nurse and senior doctor
Lab. technician
Radiologist
15
45
10
15
4
2
2
2 eller 5
2 eller 5
Senior doctor
Internist
Nurse
Nurse
240
160

10. Simulation options?

Staffing

Standardized, process-driving patient tracks

Variations over the day/month/year

Bottlenecks?

Chaos-handling

11. Conference
Keeping track
of patients in
10.000 m2

12. Logistics in ED

13. Logistics in ED
Who's next?

14. Logistics in ED
How fare are we?

15. Logistics in ED
Time from arrival – to meet the 4 hour criteria?

16. From diagnose-based
visitation to visitation
based upon somatic
symptoms

17. Diagnostic packages

35 major somatic symptoms
changed into standards
−
Biochemistry
−
Radiology
−
Specialist

18. Architecture
1.
2.
3.
Logistics
Intimacy
Inspiring for change

21. One of six diff. Inpatient rooms

22. Patient-terminal
-Internet, TV, radio
-work-station for the
staff
Flexibility

23. -Intimacy?

24. Recommendations
Focus on
1.
Flow
1.
1.
Patients that do not have immediate needs.
2.
Logistics …keeping track
3.
Don’t postpone procedures
that can be done immediately
Patient empowerment
2.
1.
Get patients to participate and
take responsibility

25. New ways of organisation in the ED..
..we are working on it.
Michael Hansen-Nord
michael.hansen-nord@rsyd.dk