One of TeamHealth’s primary goals is to optimize emergency department (ED) operations in a way that improves operational metrics and provides high-quality care and service that adds value to patients. Among the most dramatic ways to quickly improve operational metrics is to implement these five tactics that focus on front-end ED operations and change the way the staff and physicians function.
Tactic 1: Create an ED Action Team (EDAT)
Purpose: An EDAT is comprised of employees from multiple disciplines who proactively identify and manage potential and real operational issues within the ED.
Outcome: The EDAT builds teamwork and engages staff and stakeholders in proactive problem solving.
Tactic 2: Quickpass (Immediate Bedding)
Purpose: Commonly known as “Immediate Bedding” or “Hot Bedding,” QuickPass is an evidence-based practice that ensures patients see a provider as quickly as possible. TeamHealth chose to rebrand this process as QuickPass to facilitate the training and implementation of the process. QuickPass improves patient flow, decreases door-to-doctor time and improves the patient experience and satisfaction. It is to be used any time there are open beds.
Outcome: Through the quick placement of patients into appropriate treatment spaces, QuickPass improves front-end processes and metrics and enhances the patient’s perception of care and overall experience.
Tactic 3: The 5 “S” Process
Purpose: The Five “S” (5S) process is commonly used to eliminate waste and maintain good housekeeping in work areas. A well-known LEAN tool, 5S improves workplace functionality by reducing clutter and helps create a clean and inviting environment for staff and patients. This process also helps improve patients’ perceptions of the quality of care, cleanliness and overall service.
THE 5Ss
1. Sort. Take stock of the current inventory in your work area and remove everything that isn’t necessary. Ask yourself how frequently you use it, is it current or obsolete and is it is essential to the patient or provider?
2. Straighten. Organize, label and identify the locations of items that are needed in the work area. Ask yourself, “How easily and quickly can we find this when we go into the store room?” Label shelves, create space and create order.
3. Shine. When the workspace is sorted and straightened, it is time to shine up everything. Clean equipment, dust shelves and put things together so that they are assembled and ready to go. There’s no place where this is more important than in the ED.
4. Standardize. Create a method to support the first 3Ss, then develop a process to support keeping things clean, organized, labeled and in their assigned places. Set clear expectations about how the workspace will be maintained, and engage everyone’s participation in the process.
5. Sustain. Routinely review the workspace on a regular basis to ensure the area is in top form. This is all about behavior change and takes time, holding people accountable and continual monitoring.
Outcome: By implementing 5S, the work area will be organized, look better, have more usable space and function better for staff and patients. The 5S process also supports readiness for goals put forth by The Joint Commission and enhances patient and staff safety and satisfaction by keeping the work areas clear of clutter that might cause an otherwise avoidable accident.
Tactic 4: ESI Level 3 Fast Track
Purpose: For EDs where at least 35% to 40% of their triaged volumes are ESI Level 3 patients, an ESI Level 3 Fast Track can improve overall throughput similar to a traditional fast track model.
Outcome: Most EDs that implement an ESI Level 3 Fast Track see an overall reduction in LOS of as much as 40%. The resulting expedited care of ESI-3 patients improves staff, provider and patient satisfaction and also decreases LPMSE/LWOT rates.
Tactic 5: Triage Alternatives
Provider at Triage
Purpose: The Provider at Triage alternative is designed to effectively reduce door-to-provider times and door-to-pain-control times, expedite test ordering, and reduce overall LOS. By having a provider participate in triage, low-to-moderate-acuity
(ESI-3, -4, and -5) patients can be treated during triage and released after the triage phase, thereby improving timeliness of care and freeing valuable bed space for patients a higher level of care.
Team Triage
Purpose: The Team Triage tactic alternative is intended to reduce overall LOS, door-to-provider times, and door-to-pain-control times. In this tactic, the RN and provider simultaneously greet and evaluate the patient and initiate the treatment plan, thereby eliminating the often extensive delay between handoffs that occur in a traditional model.
Outcome: The Provider at Triage and Team Triage approaches are alternatives to the traditional triage tactics used by many EDs. In most cases, either of the alternatives presented here will improve patient satisfaction as well as reduce LOS, LPMSE/LWOTs, and door-to-provider times.