In May of 2006, Cedars Medical Center created an Interdisciplinary ED Redesign Team to further improve the processes in the Emergency Department. Over the past year, Cedars Medical Center’s ED has experienced several quantifiable improvements.
The teams time and effort has resulted in a significant decrease of 57 minutes from the point at which a patient arrives to the ED to when they are assigned a bed. This was determined by comparing year to date length of stay in the Emergency Room to the same time period in 2006. The decrease was achieved by implementing a no open bed policy, which means that no patient has to wait in the waiting room provided there is a vacant bed in the main ED. Additionally, the team implemented a system that required any nurse in an assigned zone to triage a patient that has been placed in a bed. This has resulted in increased flow of patients through our system and a reduction in wait times. Another intervention was the evaluation of the acuity of patients that arrived by ambulance as opposed to those brought in by Fire Rescue. The team determined that quite frequently there was no significant difference in acuity, hence the decision was made for all ambulance arrivals to be brought directly into the main ED as opposed to having the patients wait in the waiting room. The team also worked on a process to decrease the time starting at arrival to the ED to the time they are actually evaluated by a physician. Year to date, this time has been decreased by a remarkable 66 minutes. This success was attained through collaboration with the ED physicians and staff to ensure patients were being tracked more efficiently. An ED tracker was built that enabled the ED staff to monitor patient flow even from a distance via an LCD ED tracker, which acts as a large visual trigger. Physicians and staff are able to monitor the number of patients in the waiting room via Meditech which also indicates how long they have been waiting there. The evening supervisors and bed control staff has access to the same screen and are thus able to see wait times and generate questions about why patients are waiting for prolonged periods. This additional level of oversight has helped to increase awareness and again decrease wait time. Lastly, the team was also able to realize a decrease in the ED length of stay by an astounding 63 minutes year to date. The decrease in ED length of stay is truly an interdisciplinary accomplishment. Departments such as the Lab, X-Ray, Nursing, Transportation and Environmental worked together to accomplish this. The team found that there was a need for increased understanding between the ED and the patient floors. They worked together on implementing faxed reports provided there was an available room. Daily bed huddles and pre-diversion notification, as well as notification of the bed control staff of the need for a bed while awaiting admission orders, has expedited the flow of patients through the ED. Cedars Medical Center hired an admissions Nurse and evening house Supervisors to ensure a smooth process. All of these initiatives combined contributed to the overall outcomes achieved and to the success of the Cedars Emergency Department. Part of the end results is a higher than usual patient satisfaction score. The entire team deserves tremendous credit for what has been accomplished.
