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Three cost-cutting tips to improve ED patient flow

Nurse Leader Weekly, August 27, 2004

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Improving your patient flow doesn't have to be expensive. Just ask the emergency department (ED) staff at St. Rose Hospital in Haywood, CA.

Patrick Evangelista, RN, MBA, clinical nurse manager, who oversees the ED at St. Rose, says that within the past year the department has made an effort to work together to improve its patient flow problems. With the support of Armando Samaniego, MD, medical department emergency director with California Emergency Physicians, the hospital has opened up emergency beds, improved its diversion rates, reduced employee stress levels, and increased patient satisfaction.

To address patient flow and bottlenecks, the hospital, in January 2003, created an Emergency Performance Improvement Committee (EPIC), a multidisciplinary team made up of nursing staff, medical staff, licensed practical nurses, emergency room technicians, clerks, radiologists, laboratory technicians, and housekeeping staff.

The following are three steps the hospital and the EPIC team took to improve patient flow without spending a lot of money:

1. Use colored sticks to identify tests ordered. Samaniego developed a simple idea that allowed nurses to immediately see when doctors ordered tests without ever speaking to them. He purchased three dozen multicolored popsicle sticks to identify when a physician ordered a lab test, respiratory test, or an electrocardiogram (EKG). Once a physician orders a test, the unit assistant places the order and puts the colored stick in the chart. "Now I can sit in my office and from a distance see a red stick or purple stick and know that a patient needs to get an EKG done or a lab drawn," says Evangelista.

2. Use a grease board to track your patient status. The team also purchased a large grease board to track patient status for $500. The board keeps track of each patient and costs far less than the $350,000 software tracking programs the hospital was evaluating. "We can see by looking at the board whether a patient is having an EKG or if she needs a lab," Evangelista says. "It's really improved the flow because we can look at the board and see that a patient doesn't necessarily need to take up a bed, but can stay in the holding area while waiting for a lab."

3. Make better use of dead space. The hospital also created a "Medical Express Unit," which uses dead space in the hospital to move patients off monitors in the ED and free-up beds. The operating room manager allots Evangelista one to two beds in the morning and five beds in the afternoon. "This way I can move five monitored patients to the med/surg in the OR recovery room where there is a nurse with no patient load. The only cost is one nurse, and it frees up space."

-Adapted from Briefings on JCAHO newsletter (August 2004), published by HCPro, Inc.

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