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Patient Flow E-Newsletter
In this Issue: Integrating Pre-hospital and Hospital Care The need for collaboration between EMS providers and ED providers has long been acknowledged. The Institute of Medicine's 2006 report, Emergency Medical Services: At the Crossroads, highlighted the need for coordination between pre-hospital and hospital providers. This e-newsletter highlights a hospital program specifically targeted at the transfer of patients from pre-hospital care to hospital care in the ED. Another hospital shows how an organization-wide approach is necessary to address the increasing occurrence of diversion. Additionally, the Atlanta Fire Department's Medical Director speaks about the need for collaboration between EMS providers and ED staff. Best Practices Ambulance gridlock--with gurneys lined up and emergency medical services (EMS) crews waiting to offload patients--is one of the most obvious signs of poor patient flow through emergency departments (EDs). To avoid it, many EDs go on ambulance diversion, temporarily turning away new patients. But hospitals around the country are looking for more permanent solutions. Las Vegas’ Valley Hospital Medical Center adopted a "pit crew" philosophy to expedite ambulance drop-offs. The ED now uses a team approach: an RN receives report while an ED tech assists EMS crews in offloading patients. This has reduced average offload times to minutes instead of hours. The program has enabled the ED to treat more patients--increasing revenue and improving patient satisfaction. Innovations Two years ago, Presbyterian Intercommunity Hospital, near Los Angeles, was on ambulance diversion nearly 20% of the time. Hospital administrators began to see going on diversion as a symptom of a larger workflow problem. Several changes--from hiring staff EMTs to help with ambulance offloads and patient triage, to speeding up admissions and lab testing, to enlisting the help of hospitalists, intensivists, and case managers--have dramatically improved patient flow and enabled the ED to stay open nearly all hours. Hospital administrators describe this turnaround as a "culture change"--a shift from 'Let's go on diversion because we are overwhelmed' to asking 'What did we gain from going on diversion?' Perspectives
New Reports Annals of Emergency Medicine Reports on Crowding and Quality of Care Three new reports were released in the Annals of Emergency Medicine that highlight how crowding affects quality of care provided to ED patients. Two articles are associated with time to antibiotics for patients with community-acquired pneumonia and a third article examines delays in treatment for patients with severe pain. StatCom's 2007 National Survey on Patient Throughput and Capacity Challenges In a recent national survey by StatCom, more than 200 executives, directors, nurses and physicians were surveyed regarding patient throughput, bed occupancy and length of stay. Nearly three-fifths (58 percent) of health care executives stated their facilities did not have the ability to track patients continuously. Additionally, over half (53 percent) rated their facilities' bed turn process as poor or fair. | |
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One of the most important developments in emergency care has been the emergency medical services (EMS) system. As the providers of life-saving pre-hospital care, EMS has become a frontline medical resource and a vital extension of our hospital emergency departments. Dr. Jim Augustine discusses the importance of collaboration between the pre-hospital and hospital environments in delivering quality care to all patients.Copyright © 2002-2008 Urgent Matters. All Rights Reserved. | Subscribe | Unsubscribe | Contact Us | Privacy Policy