Increase timeliness and reduce delays to safe and efficient flow of patients throughout the acute care setting using the following goals:

• Decrease emergency department (ED) disposition to in-patient bed time by 66 percent to achieve a one-hour disposition
• Decrease post anesthesia care unit (PACU) disposition to inpatient bed time by 50 percent to achieve a one-hour disposition
• Maintain intensive care unit (ICU) disposition to acute care bed time of four hours
• Maintain acute care disposition to long-term care time of less than 24 hours

• Time from emergency department to placement in inpatient bed
• Time from post anesthesia care unit to placement in inpatient bed
• Time from intensive care unit to placement in inpatient bed

• Compressed the ED by closing some rooms, thereby achieving a staffing ratio of three patients per nurse, without increasing staffing levels.

• Instituted faxing of reports to receiving units. Instead of waiting for nurses on the transferring and admitting units to speak by telephone, the nurse writes a brief summary of the diagnosis on a form and faxes it, along with the nurse’s notes, to the admitting floor.

• Replaced nurse transportation from the PACU with a dedicated transport staff person, shared with two other units, saving five nursing hours per day.

• Linked discharges to admissions by predicting time of patient discharge and orchestrating discharge procedures. Patient placement then tentatively assigns a new admission to this room.

• Instituted an AM Bed Huddle where representatives from nursing clinical management, administration, patient placement, housekeeping, care management and bed coordination meet to discuss what admissions are scheduled for the day, how many patients need to be placed from the ED, how many patients need to be transferred out of intensive care unit, etc. The next day’s bed placement issues are also discussed.

The PACU decreased disposition time by 50 percent and is holding the gain. Emergency department disposition decreased from three hours to 1.8 hours and is holding at that time. The ICU initially decreased disposition time by 50 percent but did not hold the gain. And long-term care decreased disposition time in half and is holding the gain. This is not an area in need of improvement and not the focus of the team.

Lessons learned include the following:

• Communication is key
• Elicit feedback
• Senior management, physician, and staff commitment is important to success

Linda Caissie, RN, Director of Emergency Care Services linda_caissie@bshsi.com

Bon Secours Venice Hospital presented at the Institute for Healthcare Improvement's IMPACT Learning Session.  Click here to view the presentation.