This document discusses techniques to maximize efficiency in patient flow in the emergency department. It defines efficiency as the optimal utilization of resources to produce desired outcomes. The goals of improving efficiency are to enhance patient care, satisfaction, and outcomes while reducing costs and stress on staff. Key techniques include expediting the triage process, registering patients simultaneously with initial care, starting IVs and labs early, performing evaluations and tests concurrently rather than sequentially, and flexible staff coordination to speed processes. The overall approach is focused on minimizing time to initial physician exam and making sequential events occur in parallel.

1. PATIENT FLOW EFFICIENCY
TECHNIQUES IN EMERGENCY
DEPARTMENT
Dr. Manal Elsayed Abdelaziz
B.Sc. Pharm, CPHQ, DTQM, CLSSGB,
TeamSTEPPS Master Trainer

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.

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