Exploring New ED Intake Strategies

Ihc Health Services, Inc., Salt Lake City UT

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): According to the Agency for Healthcare Research and Quality (AHRQ), the emergency department (ED) is the point of entry for over half of all patients admitted to the hospital in the United States. Indeed the ED is the "front door" to the hospital. On average nationwide, 3% of patients seeking urgent healthcare will leave the ED without being seen by a physician due to unacceptable waits and delays. Thus, ED inefficiencies and delays translate into almost 4 million patients walking away from healthcare after presenting for help. Additionally, the ED is the most common site for sentinel events in the hospital due to waits and delays in care, according to the Joint Commission. Realization of the impact that these delays have on the safe and efficient care delivery has led to experimentation with other models for intake in the ED. There has been innovation with alternatives to traditional triage being explored in isolated sites around the country, some of it published, some of it unpublished. How do you redesign processes in an industry where service never stops? This means that those EDs that have been able to innovate and discover new, improved and alternative processes could help move the specialty forward in solving such problems. Those model EDs and their governing organizations need a venue to vet their findings and share their experience. This is an explicit goal of this conference-creating a learning community for enhanced quality care in EDs. The Conference on "New Intake Models for the Emergency Department" is planned as a means to bring together the nation's innovators in ED Operations with the following specific aims in mind: 1) To provide a venue for sharing the newest, proven ideas on processing patients into the department (intake) and identifying best practices that are timely, patient- centered, efficient, and safe. 2) To use the proceedings of the conference to inform healthcare policy makers of top performing operational strategies for intake into the emergency department, so that they may craft policies that encourage such strategies. 3) To begin to move quality improvement efforts in emergency medicine forward into the realm of operations management. 4) To provide a shared learning experience for the attendees and build on previous ideas of patient flow, adding to this evidence base. 5) To connect intake models for daily emergency volumes to intake models for mass casualty and natural or manmade disaster situations. This focus for a dissemination conference is timely for the nation, and timely for the patients showing up for health care in the ED. New intake models are needed to safely meet the growing demand for services as our nation faces continued strains on ED capacity driven by a painful economic downturn. Further, any solutions to the daily surge of patients arriving for intake into the emergency department would be applicable to surges due to natural disasters or terrorist attacks. Herein, we propose to create a learning community through which we can effectively disseminate best practices and collectively solve the problems with intake into emergency department. PUBLIC HEALTH RELEVANCE: Project Narrative Timeliness of care is an issue that is front and center for EDs in the United States. Indeed, the Joint Commission's patient flow standard requires hospitals to demonstrate efforts to study and improve patient flow. The debate about overcrowding has given way to dialogue about patient flow, how to measure patient flow, and how to make improvements. Timeliness of care is among the strongest correlates with patient satisfaction. If the time interval from patient arrival to the physician's evaluation increases, the rate of patients leaving without being seen (LWOBS) increases, a dangerous proposition for the patient. In terms of clinical outcomes, the impact of improved intake into the ED can't be overstated. Healthcare is on the clock for many and various clinical conditions such as heart attack, stroke, and pneumonia to name a few. These conditions have time-dependent clinical goals. When met they may dramatically influence survival and outcomes and these goals can only be met if there is no delay in seeing the physician. Minutes spent in the waiting room can worsen a patient's prognosis and compromise the ability to provide safe, high quality care. Finally, all innovation that expedites patient care in the emergency department is applicable to disaster preparedness. Improving the ability of our nation's emergency departments to intake patients would be of great importance to disaster management. The proposed conference aims to identify and disseminate the strategies and processes used by top performing emergency departments in the realm of ED Intake. These new ideas will be presented and detailed at a very granular level for the benefit of attendees and for dissemination to a wider audience through print media. In addition, health care policy makers will be invited to help them better understand the problem, the constraints, and the solutions being developed. They may in turn craft policies that create incentives for health organizations to address these problems.