2. • Introduction
• Before reaching ER
• After Reaching ER including triaging
• When patient in ER
• Bed transfers ,availability of IP BEDs
• Concept of CFMU
• Patient transfers and disposition
3. • Understand a high-level overview of ED patient
flow and operations
• Identify the common obstacles to efficient flow
and how to optimize your practice and
performance
• Recognize opportunities to optimize patient flow
for staff and patients
• Outline a plan to reduce delays and improve
patient throughput
• Identify new technologies and methodologies
that improve patient flow
4. • Mark all key points from the road to the ED
entrance
• Provide a welcoming destination inside the
department
• Eliminate the negative associations of waiting
rooms
• Improve way finding to treatment areas
6. Pre-care strategies
• Nurse triage and a phone line
• Psychiatry patients to have access to a health
care professional and determine whether a
visit to the ED is appropriate.
• While it is not required to be in the ED
• Proximity to the triage area is helpful because
it allows access to colleagues for more in-
depth consults.
7. In-care strategies
• When a patient receives care
• Use the technology and space to coordinate with
primary care teams
• Coordinated treatment
• Sharing vital information about the patient
without incurring the costs of duplicated tests.
8. Post-care strategies
• Medical care coupled with lifestyle changes
• Compliance with medication directives often
is not achieved
• Clinical pharmacist for drug briefing
9. • Social workers and a dedicated follow-up
referral specialist
• Centralized ED follow-up office
• Transition planners for elderly patients.
10.
11. Improving Patient Flow: Key Strategic
Concepts
• Demand/Capacity Management
• Real-Time Monitoring of Patient Flow
• Know your Constraints
• Managing Variation Managing Variation
• Teamwork and Culture
• Understand the Psychology of Waiting
patients
12. • Door to Doctor time
• Length of stay
• ER Boarding
• Administrative support!
• Why Re-design your ED?
– Increasing volume?
– Not enough space?
– Not enough facilities?
– Poor layout?
ED Design / Re-design
13. A Classic better ED
• Enhanced Triage
• A Fast Track system
• Bedside Registration
• Efficient Ancillary Services
• Lab and Radiology
• A Results-Waiting Area
• Efficiently Managing Admissions and Discharges
14. Triage is a process, not a
place…
• Improve Throughput
• Increase Safety
• Improve Quality
• Increase Satisfaction
• Increase Revenue
• Decrease Cost
15.
16. Vertical v/s Horizontal patients
Vertical Patients
• Ambulatory
• Arrived by triage
• Well
• Younger
• Precived urgency or
conveninence
Horizontal patients
• Stretcher bound
• Arrive by ambulance
• Sick
• Older
• Precived serious or life
threatening
17. Fast track
• To segment and serve those patients that are
uncomplicated or relatively easy to treat
• Not a casual add-on or an overflow unit
• A way for relatively easy to treat patients
• Should be by an experienced doctor
18.
19. Patients should be in a bed only if it is
medically necessary and only as long as
medically necessary
20.
21. Once patient reaches the bed
• Make sure that the best available team attends
the patient
• Tailor the hours and staff to the facility and to
patient flow
• Job description should be clear
• Make sure your ancilliary services are on place
23. • Doctors, Nurses & Support staff
• Healthy relationship is of paramount
importance.
• Be a team player
• Let them know your plan
Team Work!!!
24. ED physcians….
• Capable of working together
• Team Leaders
• Team Followers
• The strongest
• Advocates for nurses in the ED
25. CFMU
• Clinical forensic medicine unit
• This Unit which will be responsible for all
smedico legal services relating to clinical
departments
• Run by the forensic experts
• Active 24x 7
26. • Will be intimated to them if a MLC arrive sto ER
• Filling up the MLC case sheets,photographs if
needed,collecting all the medicolegal evidences
• Intimating the police,filling up the wound
certificates,dealing with brought dead cases…
• Anything related to MLC
• Clinicians can concentrate on patient care
27.
28. Discharge process
• Start planning as early as your first contact
with patient
• Fill out the d/s immediately.
• Do not wait for secondary/cross consultations
and evaluation.
• Pharmacy nearby for dispensing medications
• Single window billing
29. Improving ED Patient process innovate in….
• Optimize and maximize patient Intake
• Optimize the Triage and Fast track
• Get the most out of your ED Bed capacity and bed
utilization
• Leverage clinical talent and time
• Maximize bed turns
• Teamwork and Culture
• Minimize the boarding burden
• Accelerate the Admissions Process
30. • Start from the Front end
• Triage / Fast track - Should be a process, not a
place
• Decrease the door to doctor time!
• Horizontal v/s Vertical patient
• Patient v/s Customer
• Teamwork & Communication
• Review & Critiquing
To Summarize…
Editor's Notes
What are you trying to solve?
Dr.Alazamani, in Kualalmpur – undercover as hospital attendant, assistant medical officer and nurse.
