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Express care improves patient flow in the ED

Quality Improvement Monitor, July 4, 2008

Sun Health Del E. Webb Hospital in Sun City West, AZ, was in trouble. From 2002 to 2007, the ED had seen an 87% growth in volume. Patient satisfaction was low, employee turnover was high, and most patients waited eight hours to be seen.

“Our patients hated us. They told us loud and clear on Press Ganey,” says Noreen Vanca, RN, BSN, MS, administrative director of emergency services at Sun Health.

Like many other ED managers, Vanca knew something had to be done. In 2006, she began implementing the concept of fast-tracking patients with minor and nonacute injuries.

At Rockford (IL) Health System, ED educator Jeff Berg, RN, BSN, TNS, also knew that by treating patients with nonacute injuries (about 25% of his ED volume) differently, he could increase patient satisfaction. A large problem with EDs, he says, is that patients come in with nonacute injuries or even nonemergencies. “These patients could have sore throats, ankle sprains, simple lacerations, or need a prescription refill,” says Berg. “It’s a mix of minor injuries and complaints that used to go to physicians’ offices that, throughout the nation, are ending up in our EDs now.”

Berg says fast-tracking appealed to him because it did not require other departments to be heavily involved in the process change.

“The concept is to get the patients and either their physicians or their providers together as soon as possible. One way to do that is to identify on the front end those patients that are really easy or simple to treat,” says Kirk Jensen, MD, MBA, FACEP, chief medical officer of BestPractices, a provider group of emergency medicine outsourcing services in Fairfax, VA. Jensen also chairs the Institute for Healthcare Improvement’s IMPACT Learning and Innovation Communities, which focus on patient flow in acute care settings and operational and clinical improvement in the ED. He has worked with hundreds of EDs.

Access the full story in the July issue of Quality Improvement Report; access is free for subscribers, nonsubscribers can purchase a copy of the story for $10.

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