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PATIENT FLOW EFFICIENCY
TECHNIQUES IN EMERGENCY
DEPARTMENT
Dr. Manal Elsayed Abdelaziz
B.Sc. Pharm, CPHQ, DTQM, CLSSGB,
TeamSTEPPS Master Trainer
Definitions of “Quality”
 The famous experts in the
subject define “quality” in the
following ways:
“Meeting of customers’ needs”
(W. Edwards Deming);
“Fitness for use” (J.M. Juran);
“Conformance to requirements”
(Philip B. Crosby).
Definitions of “Quality”
 “degree of conformity
with accepted principles
and practices
(standards), the degree
of satisfying the
patient’s needs, and the
degree of attainment of
acceptable outcomes,
while making
appropriate use of
resources.” (JCI)
Efficiency:
It is one of the most important
key dimensions of quality.
It is the optimum utilization of
resources to produce the
desired outcomes.
Goals of Trying to Maximize
Patient Flow Efficiency in the E.D.
 Improve patient care
 Improve patient satisfaction with care
 Lessen stress on E.D. staff
 Limit financial costs to hospital
 Allow more available staff time for
teaching
What Does Maximizing Patient
Flow in the E.D. Really Mean ?
 Limiting as much as
possible the time
intervals between each
sequential event that is
necessary for patient
care
 Maintaining quality,
safety, completeness,
empathy, and personal
attention in patient care
Fundamental Principles Behind
Improving Patient Flow Efficiency
 Anything that delays evaluation by
the emergency physician is
detrimental
 Everyone in the department must
be committed to & cooperative
with efficiency efforts
 Provision of emergent care
procedures always takes
precedence
 Making events simultaneous rather
than sequential increases
efficiency
Remember!
Maintaining efficiency
and speed are important
even when the E.D. is not
busy, because this
enables the E.D. to
better handle a sudden,
unexpected influx of
patients
Nursing Triage : Background
Aspects Related to Efficiency
 Both CBAHI & JCI standards require that all
patients be medically evaluated prior to being
asked to register
 Triage should take < 3 minutes maximum per
patient
 Space & seating allowance necessary for multiple
simultaneous presenting patients
ER.8 There is an effective triage process to prioritize emergency
patients.
ER.8.1 There is a process to identify patients with urgent or
emergent care needs.
ER.8.2 Patients with urgent or emergent needs are given priority for
assessment and appropriate and
timely care.
ER.8.3 Re-triage is performed when appropriate (e.g., change of
medical condition, long waiting time).
What Exactly Constitutes Proper
Efficient Nursing Triage ?
Immediate "experienced eyeball"
assessment of the patient's
condition
"One line" chief complaint
Vital signs :
o Pulse
o BP
o Resp. rate
o Temp.
Current meds & allergies
Patient Disposition Options
for the Triage Nurse
Take patient immediately back
to emergency care area
Send patient to E.D. registration
Send patient to a "non-
emergent" care area
Send patient to X-ray or
laboratory prior to being sent
into E.D.
o By preapproved written protocol
based on chief complaint
Time-Saving Techniques at
Registration
 If others accompany the
patient, have them register the
patient while triage and initial
E.D. care are started
 Automatically obtain patient's
recent E.D. chart to
accompany current chart
Standard Efficiency Criteria
for Initial Patient Care
 For any potentially unstable patient,
nursing should go ahead with O2 (2
L/min.), monitor, IV, blood draw, ECG,
pulse oximetry, & early ER Physician
notification
 X-ray +/- resp. techs may need to be
notified & activated, but ER Physician
should see patient prior to their
actions
 ER Physician should be notified of
priority of multiple simultaneous
patients
Patient Evaluation Efficiency
Techniques for Physicians
For several near-simultaneous
patients :
oSee 1 or 2 simple cases only
requiring exam or single x-ray
first, then see a more
complex or involved patient,
then recheck the x-ray
results for the simple cases
while awaiting lab, etc. for
the complex case
oHold data completion till after
all these patients are seen
Draw & send lab tests early if
needed
o Pelvic & secondary exams should
be done after lab is sent
o Hold split urine specimen + extra
blood tubes in case secondary
tests prove needed
Complete entire physical
exam prior to ordering X-rays
so all films can be done at
once
Patient Evaluation Efficiency
Techniques for Physicians
Patient Evaluation Efficiency
Techniques for Physicians
 Lengthy non-resuscitative
procedures on patients who are
definitely going to be admitted
anyway should not delay evaluation
& disposition of patients with simple
or more minor problems
 Verify specific times that labs were
sent to know when to check up on
them
 Once a stable case is turned over to
a consultant, don't hover over the
patient
Suturing Efficiency Techniques
for E.D. Physicians
 Have equipment obtained &
set up while you are doing
the H&P
 Don't X-ray the wound for
foreign bodies if you can
explore it directly
adequately
 Have staff obtain discharge
meds & instructions while
suturing is being done
Charting Efficiency Techniques
for E.D. Physicians
Dictate/Write charts
whenever free time is
available
o May split dictation (dictate initial
H&P first ; then later add
addendum dictation once lab &
disposition are known)
 Leave charts in the locations
where they're supposed to be so
time is not wasted tracking them
down
Interactive Efficiency
Techniques for E.D. Staff
 Don't be rigid about job duty
performance
o Helping someone else with their job
may speed things up a lot
o Extra attention should be directed
to help the person who is the most
busy
 Let E.D. staff know your patient
care plans so they can
anticipate further actions
 Have flexible room coverage
assignments
Improving E.D. Patient Flow
Efficiency : Summary
 All E.D. staff should take interest
& pride in efficient patient flow
 Anticipation and cooperation are
key
 "Mapping out" of short term
events is helpful in planning
 System should be geared to
minimize time to initial ER
Physician exam. & to make
events simultaneous rather than
sequential
Patient flow efficiency techniques in emergency department

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Patient flow efficiency techniques in emergency department

  • 1. PATIENT FLOW EFFICIENCY TECHNIQUES IN EMERGENCY DEPARTMENT Dr. Manal Elsayed Abdelaziz B.Sc. Pharm, CPHQ, DTQM, CLSSGB, TeamSTEPPS Master Trainer
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  • 3. Definitions of “Quality”  The famous experts in the subject define “quality” in the following ways: “Meeting of customers’ needs” (W. Edwards Deming); “Fitness for use” (J.M. Juran); “Conformance to requirements” (Philip B. Crosby).
  • 4. Definitions of “Quality”  “degree of conformity with accepted principles and practices (standards), the degree of satisfying the patient’s needs, and the degree of attainment of acceptable outcomes, while making appropriate use of resources.” (JCI)
  • 5. Efficiency: It is one of the most important key dimensions of quality. It is the optimum utilization of resources to produce the desired outcomes.
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  • 8. Goals of Trying to Maximize Patient Flow Efficiency in the E.D.  Improve patient care  Improve patient satisfaction with care  Lessen stress on E.D. staff  Limit financial costs to hospital  Allow more available staff time for teaching
  • 9. What Does Maximizing Patient Flow in the E.D. Really Mean ?  Limiting as much as possible the time intervals between each sequential event that is necessary for patient care  Maintaining quality, safety, completeness, empathy, and personal attention in patient care
  • 10. Fundamental Principles Behind Improving Patient Flow Efficiency  Anything that delays evaluation by the emergency physician is detrimental  Everyone in the department must be committed to & cooperative with efficiency efforts  Provision of emergent care procedures always takes precedence  Making events simultaneous rather than sequential increases efficiency
  • 11. Remember! Maintaining efficiency and speed are important even when the E.D. is not busy, because this enables the E.D. to better handle a sudden, unexpected influx of patients
  • 12. Nursing Triage : Background Aspects Related to Efficiency  Both CBAHI & JCI standards require that all patients be medically evaluated prior to being asked to register  Triage should take < 3 minutes maximum per patient  Space & seating allowance necessary for multiple simultaneous presenting patients ER.8 There is an effective triage process to prioritize emergency patients. ER.8.1 There is a process to identify patients with urgent or emergent care needs. ER.8.2 Patients with urgent or emergent needs are given priority for assessment and appropriate and timely care. ER.8.3 Re-triage is performed when appropriate (e.g., change of medical condition, long waiting time).
  • 13. What Exactly Constitutes Proper Efficient Nursing Triage ? Immediate "experienced eyeball" assessment of the patient's condition "One line" chief complaint Vital signs : o Pulse o BP o Resp. rate o Temp. Current meds & allergies
  • 14. Patient Disposition Options for the Triage Nurse Take patient immediately back to emergency care area Send patient to E.D. registration Send patient to a "non- emergent" care area Send patient to X-ray or laboratory prior to being sent into E.D. o By preapproved written protocol based on chief complaint
  • 15. Time-Saving Techniques at Registration  If others accompany the patient, have them register the patient while triage and initial E.D. care are started  Automatically obtain patient's recent E.D. chart to accompany current chart
  • 16. Standard Efficiency Criteria for Initial Patient Care  For any potentially unstable patient, nursing should go ahead with O2 (2 L/min.), monitor, IV, blood draw, ECG, pulse oximetry, & early ER Physician notification  X-ray +/- resp. techs may need to be notified & activated, but ER Physician should see patient prior to their actions  ER Physician should be notified of priority of multiple simultaneous patients
  • 17. Patient Evaluation Efficiency Techniques for Physicians For several near-simultaneous patients : oSee 1 or 2 simple cases only requiring exam or single x-ray first, then see a more complex or involved patient, then recheck the x-ray results for the simple cases while awaiting lab, etc. for the complex case oHold data completion till after all these patients are seen
  • 18. Draw & send lab tests early if needed o Pelvic & secondary exams should be done after lab is sent o Hold split urine specimen + extra blood tubes in case secondary tests prove needed Complete entire physical exam prior to ordering X-rays so all films can be done at once Patient Evaluation Efficiency Techniques for Physicians
  • 19. Patient Evaluation Efficiency Techniques for Physicians  Lengthy non-resuscitative procedures on patients who are definitely going to be admitted anyway should not delay evaluation & disposition of patients with simple or more minor problems  Verify specific times that labs were sent to know when to check up on them  Once a stable case is turned over to a consultant, don't hover over the patient
  • 20. Suturing Efficiency Techniques for E.D. Physicians  Have equipment obtained & set up while you are doing the H&P  Don't X-ray the wound for foreign bodies if you can explore it directly adequately  Have staff obtain discharge meds & instructions while suturing is being done
  • 21. Charting Efficiency Techniques for E.D. Physicians Dictate/Write charts whenever free time is available o May split dictation (dictate initial H&P first ; then later add addendum dictation once lab & disposition are known)  Leave charts in the locations where they're supposed to be so time is not wasted tracking them down
  • 22. Interactive Efficiency Techniques for E.D. Staff  Don't be rigid about job duty performance o Helping someone else with their job may speed things up a lot o Extra attention should be directed to help the person who is the most busy  Let E.D. staff know your patient care plans so they can anticipate further actions  Have flexible room coverage assignments
  • 23. Improving E.D. Patient Flow Efficiency : Summary  All E.D. staff should take interest & pride in efficient patient flow  Anticipation and cooperation are key  "Mapping out" of short term events is helpful in planning  System should be geared to minimize time to initial ER Physician exam. & to make events simultaneous rather than sequential