This improvement story originally appeared in IHI's 2004 Progress Report.
Lee Memorial Hospital (Fort Myers, Florida, USA) reduced their emergency department to inpatient bed transfer time by 80 percent, using techniques learned in IHI's Improving Patient Flow Collaborative.
Emergency departments are commonly thought to be overcrowded because they are not big enough to accommodate the needs of their communities. But a recent report on emergency department (ED) overcrowding by the US General Accounting Office said this: “. . . the factor most commonly associated with crowding was the inability to transfer emergency patients to inpatient beds
once a decision had been made to admit them as hospital patients rather than to treat and release them.”
Staff from Lee Memorial Hospital in Fort Myers, Florida, learned the same thing at an IHI IMPACT meeting on improving patient flow. By putting in place the steps they learned, they were able to reduce transfer time from the ED to an inpatient bed by 80 percent.
Linda Biittner, RN, facilitated the flow team at Lee Memorial. She and her colleagues began by doing something counterintuitive: improving the nurse-to-patient ratio in the ED from 1:4 to 1:3. “There were always patients just waiting to be discharged. When you have three other patients, that discharge is not your priority, so they have to wait,” says Biittner. “Reducing the nurses’ patient load lets them be far more productive.”
They also introduced bedside registration, as well as a new computer-based system that tracks how long admitted patients have been in the ED. “I can pull a computer report on how long our patients are waiting, or how long each doctor spends with patients, and that helps us understand our flow better,” says Biittner.
ED staff now fax reports to nurses on inpatient units prior to transferring patients, eliminating the time-consuming telephone tag that often preceded such transfers. To assure that beds are ready when patients arrive, they created a bed turnaround team. Today, the only person allowed to call a “stat clean” is the patient flow coordinator. “Every time someone called a stat clean, it took everyone away from the job they were supposed to be doing,” says Biittner. Bed turnaround has been reduced from an average of 38 to 21 minutes.
“It requires ongoing vigilance,” says Biittner, “you have to keep revisiting the changes you’ve made to make sure they are being carried out consistently. But we have proven that we are on the right track.”