Improvement Report: Improving Flow Through the Acute Care Setting

Baptist Memorial Hospital—Collierville
Collierville, Tennessee, USA

Team
Joe Holley, MD, President of Medical Staff (Pilot Team Leader)
Tim Kemp, MD, Emergency Medicine Physician (Team Champion) Carol Pahde, RN, Emergency Department Manager (Day-to-Day Leadership)
Lauren Porter, Director of Quality
Maggie Roaten, RN, Manager of Medicine, Surgery Unit and Intensive Care Unit (Improvement Advisor)
Rebecca Blanchard, RN, Manager of Case Management
Angie Sanderson, Manager of Admissions
Debbie Buchanan, RN, Medicine, Surgery Unit
DeDe Cowden, RN, Emergency Department
Phil Vaughn, Manager of Environmental Services
Renee Pearson, Head Nurse, Post Anesthesia Care Unit
Trinity Thomas, Head Nurse, Intensive Care Unit
Jimmy Drumwright, Chief Nursing Officer


Aim
Reduce turnaround time of patients placed from the emergency department (ED) to an inpatient bed within one hour of the decision to admit.

Measures
Median time in hours from the decision to admit to physical placement in an inpatient bed of sampled patients in the emergency department.

Changes
  • Developed a "fax report" to use instead of playing phone tag between nursing units and created better consistency
  • Created a "high vensus" plan with Environmental Services for cleaning rooms
  • Improved turnaround time of ambulance services picking up discharging patients
  • Broke through a culture of mistrust between nursing departments regarding transferring patients
  • Developed a spreadsheet/graphing tool to track individual ED physician’s turnaround times
  • Acquired a dedicated fax to receive "fax reports" from other nursing units
  • Allowed the House Supervisor/Charge Nurses to become "bed coordinators"
  • Reduced batching of patients to be admitted from the ED
  • Utilized more protocols in the ED to help speed up care
  • Standardized the discharge process for nursing in the ED
  • Hired two technician positions in the ED to help during peak times
  • Moved patients from the exam room to the lobby if only waiting for test results
  • Acquired a dedicated pager for the House Supervisor/Charge Nurse to notify of incoming admissions
  • Developed a video for use in the waiting room to help educate patients regarding the ED triage process, advance directives, etc.
  • Developed a shorter patient information sheet for ED Admissions
  • Developed a "fax report" for Intensive Care Unit and Post Anesthesia Care Unit
  • Utilized volunteer staff in ED Admissions during peak times
  • Utilized nursing interns to assist with discharge paperwork
  • Developed "fax report" to local nursing home to speed up the discharge process
  • Working with an orthopedist to anticipate discharge date/time for his total hips/knees


Results

Graph_BaptistMemorialHospital_1.jpg

Summary of Results / Lessons Learned / Next Steps

By implementing these changes, we have reduced the median time in hours from the decision to admit a patient from the ED to placement in an inpatient bed from 3 hours and 45 minutes to 1 hour and 31 minutes.

 

Lessons Learned

  • Administration support of this project is key to our success
  • Staff responded well to the rapid cycle of changes — they see results immediately
  • Departments learned to trust each other
  • A smaller facility like ours was somewhat easier to make changes in and see results more quickly
  • Staff is not as afraid to try new things — if it does not work, just change it


Contact Information
Lauren Porter, Director of Quality
Baptist Memorial Hospital 
Lauren.Porter@BMHCC.org

 

[Storyboard presentation at IHI's National Forum, December 2003]

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