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Innovative strategies to improve Emergency room work flow

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Sreekrishnan Trikkur

This document discusses strategies to optimize patient flow in emergency departments. It outlines steps that can be taken before, during, and after a patient's emergency room visit to improve efficiency and patient care. These include improving triage processes, using fast tracks for less severe patients, coordinating with ancillary services like labs and radiology, and expediting discharges and transfers. The document emphasizes improving communication between doctors, nurses, and other staff through teamwork. It also discusses leveraging technology and monitoring metrics like door-to-doctor times to continuously monitor and enhance patient flow. The overall goal is to reduce delays and improve the experience and outcomes for patients.

Healthcare
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Innovative Strategies to Optimize Your Emergency Department’s Flow Dr Sreekrishnan T P Amrita Institute ,Kochi
• 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
• 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
• 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
Improve Patient Care, Safety & Satisfaction
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.
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.
Post-care strategies • Medical care coupled with lifestyle changes • Compliance with medication directives often is not achieved • Clinical pharmacist for drug briefing
• Social workers and a dedicated follow-up referral specialist • Centralized ED follow-up office • Transition planners for elderly patients.
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
• 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
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
Triage is a process, not a place… • Improve Throughput • Increase Safety • Improve Quality • Increase Satisfaction • Increase Revenue • Decrease Cost
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
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
Patients should be in a bed only if it is medically necessary and only as long as medically necessary
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
Doctor PatientNurse Communication
• Doctors, Nurses & Support staff • Healthy relationship is of paramount importance. • Be a team player • Let them know your plan Team Work!!!
ED physcians…. • Capable of working together • Team Leaders • Team Followers • The strongest • Advocates for nurses in the ED
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
• 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
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
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
• 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…
Innovative strategies to improve Emergency room work flow
Innovative strategies to improve Emergency room work flow

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Innovative strategies to improve Emergency room work flow

  • 1. Innovative Strategies to Optimize Your Emergency Department’s Flow Dr Sreekrishnan T P Amrita Institute ,Kochi
  • 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
  • 5. Improve Patient Care, Safety & Satisfaction
  • 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

  1. What are you trying to solve?
  2. Dr.Alazamani, in Kualalmpur – undercover as hospital attendant, assistant medical officer and nurse.