Highmark Emergency Department Throughput Project

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Team ID: 
940
College / Administrative Unit: 
Medicine, College of
Date Started: 
July 2009
Objective: 
To measure, report, and improve the Emergency Department throughput efficiency (patients’ visits to the Emergency Department).

Divided work into 3 Workgroups; all groups initially met every 2 wks for the first 4 months, the 2 groups met monthly. IT/Data Warehouse/Connected vital for report generation & developing coordinated electronic solutions for orders, IER, ED FirstNet & bed queuing & pt flow process integration.

Demonstrate decreasing trends in all measures:
Emergency Department Measures:
Door to Provider (from 24 minutes to 16.2 minutes) Left without Treatment/without being seen (LWOTs)(43 pts down to 15 pts month)= 0.9% to 0.3% of all pts seen/month ED Length of Stay (LOS) for discharged patients(187 minutes down to 168 minutes)

Hospital Measures:
Door to ED departure times for inpatients (not meeting goal) and observation patients (619.8 minutes down to 415.8 minutes) Admit order to ED departure for inpatients (141.6 minutes to 144.6 minutes) and observation patients (210.6 minutes down to 173.4 minutes).
Desired Results: 

Meeting 6 out of 7 measures of success so far- Project July 09- through Mar 10.
See measures under objective for speciific details.

1. Instituted Troponin POCT in the ED (test resulted in 10 minutes vs 60 minutes from the lab).
2. Instituted ED Consult and Patient Disposition Policy (90 minute Consult to Admit Order Response time). Provide weekly/monthly reports to Clinical Chairs & Quality Physician Liaisons. Overall Medical Staff median response time decreased from 102 minutes to 85.8 minutes as of Feb 1, 2010.
3. Implemented new ED Bed Request Order process (2/12/10) to alert Admissions/ Service Line Charge Nurses of potential admission requiring bed (hope to reduce overall ED LOS by patients being in the electronic queuing system earlier in the ED stay).
4. Expanded Express Admission Unit (EAU)time open to 14 hrs/5 days/wk, added telemetry to all 10 beds, ED patient priority for EAU bed placement.
5. Inclusion of patient discharge status and potential for up or downgrade in level of care in new electronic Hand-Off Communication Form (target 3/10).

Contact Person: 
Cheri West
Members:
  • Glenn Geeting, Champion
  • Joseph Geskey, Champion
  • Jill Arnold, Member
  • Lori Bechtel, Member
  • Jim Bennett, Member
  • Nancy Carrington, Member
  • Robert Cherry, Member
  • Brian Cosner, Member
  • Chris DeFlitch, Member
  • Lynn Doherty, Member
  • Steven Ettinger, Member
  • Carol Freer, Member
  • Evelyn Hall, Member
  • Patti Hart, Member
  • Ed Lankford, Member
  • Kate Millay, Member
  • Heather Moore, Member
  • Jane Musser, Member
  • Kim Oglesby, Member
  • Susan Osif, Member
  • Colleen Rafferty, Member
  • Spence Reid, Member
  • Nancy Savel, Member
  • Jodi Southam, Member
  • Andrea Stoner, Member
  • Monica Straub, Member
  • Nicole Swallow, Member
  • Debbie Swinko, Member
  • Molly Wood, Member