How 6 Easy Changes Can Reduce ED Wait Times

January 31, 2014
iVantage Health

Paula Knowlton, Client Relations Manager

How many times have you been to the Emergency Department and had to sit in the waiting room for what seemed like forever? It’s a common challenge for hospitals everywhere; here’s how one rural hospital in the Northeast addressed the situation.

At this facility, patients were repeatedly asked to sit in the waiting room two or three times before being brought to an exam room to be seen by a provider. The total “throughput” time of 2.9 hours per patient on average was deemed too long and the hospital decided to do something about it.

The first step was to find out why. Over the course of 12 weeks, hospital staff followed their patients, nurses and providers and documented the flow of the ED visit. The patient flow seemed to be the biggest glitch.

Patients not needing immediate care were waiting between 13 and 76 minutes from arrival to exam room. Upon arrival, the patient would be met by a clerk who would document the chief complaint and begin registration; then the patient would be asked to sit in the waiting area until the triage nurse would retrieve him and ask why he was at the ED.  Once triage was completed, the patient was escorted back to the waiting area, until a “room” nurse would come and escort him back to an exam room where the nurse would ask the patient to again explain why he was at the ED; then the provider would come in to conduct the medical screening exam, asking the patient again why he was in the ED. If you are keeping count, patients were asked 4 times why they were in the ED ” far too many.

Other issues adding to the length of visit were waiting for test results, providers taking on more patients than others, spreading them too thin, no standardized communications and no “real” charge nurse.

The new process

  1. Patient presents to ED and is met by a clinician for triage and a quick registration.
  2. The RN charge nurse brings the patient back to an exam room immediately (if bed is available).
  3. Have team evaluation with provider and RN for high acuity patients (Levels 1, 2 and 3). Discontinue RN full assessment for low acuity patients (Levels 4 and 5)
  4. Institute provider bedside order entry, using computer workstations in room to eliminate delays from provider interruptions and enable direct discharge from the room.
  5. When test results are back the charge nurse is responsible for flagging the patients chart for the provider.
  6. While the patient is waiting for test results the clerk is able to go into the room and do a full registration. Reducing the time the patient sits in a room with no contact by a staff member. Also improving HIPPA and EMTALA compliance.

The results? By changing patient flow, utilizing bedside order entry, having the charge nurse be just that ” charge nurses, and changing the registration process of those non-emergent ED visits, this small rural hospital was able to decrease their total throughput time from 2.9 hours to 1.8 hours.

The hospital also decreased the number of patients who left before triage by 100%, those that left without treatment by 79% and those that left without complete service by 25%. Patients sitting in the waiting room were decreased by 81% and their patient satisfaction scores increased 4%.

The 2013 National Rural Emergency Department Study shows that small rural hospitals have faster throughput than the larger urban facilities. The small rural hospitals see patients on average in 29 minutes from arrival to medical screening exam, about half the time it takes for the larger urban facilities. The average total throughput time for small rural hospitals is 123 minutes, much shorter than the 247 minutes for the urban facilities.

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