The Urgent Matters Toolkit is a collection of strategies and tools designed to target specific issues facing hospital emergency departments. This toolkit has been developed by hospitals across the country in conjunction with the Urgent Matters national program office at The George Washington University. Our goal is to continue to grow and expand the toolkit and make these resources available to the public.  

Conceptual Model of ED Flow
Tools are categorized using the Conceptual Model of ED Flow: There are numerous ways that patients can flow through the ED. The conceptual model used here captures common facets of every ED stay. These are:
  • A-Arrival (i.e.: door-to-doc, straight back, ESI),
  • B-Bed placement (i.e.: treatment space, internal waiting room, fast track),
  • C-Clinician initial evaluation (nurse, physician, or midlevel provider) & Throughput (i.e.: lab and imaging intervals, data to decision time),
  • D-Disposition decision (i.e.: bed flow, flow coordination, consults) and
  • E-Exit (i.e.: bed assignment interval, departure time, continuity of care) from ED

These five time points are commonly used when standardizing ED operational definitions. The ABCDE model is not affected by time of registration, nor immediate bedding strategies. To accommodate a physician-in-triage and scenarios where patients may be evaluated prior to bed placement, the conceptual model is flexible and can be adjusted, as seen with the ACBDE and ACDE scenarios shown in the figure above. Combined with the ABCDE scenario, these encompass nearly all of the possible flow scenarios seen in modern EDs. Using a conceptual model that is common to the majority of EDs allows similar segments (i.e. bed-to-clinician evaluation or BC interval) to be compared across EDs as well as between pre and post EHR implementation at a single facility.

Each strategy in the toolkit contains information about the hospital where the work originated, details about the implementation and outcomes, and related tools and documents.  Strategies are organized by the five categories above, A, B, C, D, E, and each contains key words, clinical areas affected, and the staff involved.     

 

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