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Emergency Room Wait Times
Plan-Do-Study-Act (PDSA)
Direct Bedding
Triage Protocols
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Plan-Do-Study-Act (PDSA)
• What is a PDSA?
– Plan an action – Implement Change/ Test – Review the results
of the Change/ Test – Change your process to improve flow or
efficiency
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ER PDSA #1 – Direct Bedding
• Marshall Naquin, MD – ER Physician • Glen Jorgensen, RN – ER
Charge Nurse • Sarah Welch – Imaging Radiology Technician • Scott
Devlin – Laboratory Assistant • Ellen Hodges, MD – Chief of Staff
• Barbara Jacobson, RN – Chief Nurse Executive • Patricia Smith –
Patient Care Services Administrator
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What is our Opportunity For Improvement?
• Long wait times for patients being seen in the ER (Length of
Stay)
• Long wait times for patients to be triaged and brought back
to a room
• Low patient satisfaction • Low employee satisfaction
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What is the current process?
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What are we going to do about it?
• Goal Statement – Decrease patient length of stay in the
ER
(total time patient is in the ER)
• Aim Statement – Decrease ER door to ER bed by 35% and
decrease overall length of stay by 10% by July 15, 2013
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How are we going to achieve our Aim?
• Direct Bedding Starting June 1, 2013 – When 4 beds are open
in the ER patients will
not wait for triage, patients will be taken directly back to an
ER room for evaluation and treatment
– When the ER is down to two beds available we will use the
triage model
– Direct Bedding will resume when there are no patients in the
waiting room and there are 4 open beds in the ER
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What will be the new process?
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Mid-Cycle Changes?
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Results… 1. Decreased average ER door to bed time by 40%
(exceeded goal by 5%) 2. Decreased overall average length of
stay by 26%
(exceeded goal by 16%)
Month Total Pa+ents Average LOS
Door to Bed Time in Minutes Jan
207* 4:47 129
Feb 1,930 4:07 121
Mar 2,195 3:58 112
Apr 2,092 5:14 149
May 1,952 4:04 101
Jun 1,847 3:08 68
Jul 1,950 3:17 78
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Results… 1. Increased patient satisfaction by 29% over
patients
using the Triage Model 2. Direct Bedding occurring 25-50% of
the time 3. 40.6% of staff feel this process makes their job
easier 4. 82.4% of staff feel that patients are better off with
this
process 5. 77.2% of staff are satisfied to very satisfied with
this
process 6. Anecdotal Comments:
– ER not getting backed up quite so early in the day –
Patients feel welcomed and important – Direct Bedding works well
everyone has a role and patients are
pleased with the expedited care
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Change to the process?
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ER PDSA #2 – Triage Protocols
• Jeff Clark, RN – ER Nurse Manager • Scott Cox – Laboratory
Manager • Arthur Freitas – Director of Diagnostic Services •
Ellen Hodges, MD – Chief of Staff • Barbara Jacobson, RN – Chief
Nurse Executive • Patricia Smith – Patient Care Services
Administrator
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What is our Opportunity For Improvement?
• Long wait times for patients being seen in the ER (Length of
Stay)
• Long wait times for patients to be triaged and brought back
to a room
• Low patient satisfaction • Low employee satisfaction
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What are we going to do about it?
• Goal Statement – Decrease patient length of stay in the
ER
(total time patient is in the ER)
• Aim Statement – Decrease ER door to ER discharge by 10%
by May 1, 2014
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How are we going to achieve our Aim? Triage Protocols for top 10
Chief Complaints
1. Abdominal Pain Male 2. Abdominal Pain Female 3. Bleeding
in Pregnancy < 20 weeks 4. Chest Pain > 30 years old 5.
Allergic Reaction > 18 years old 6. Extremity Injury 7.
Asthma/ COPD > 18 years old 8. Sore Throat > 3 years old 9.
Suspected UTI > 18 years old 10. Infant Fever 0-90 days
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What is the current process?
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New process?
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Changes Required
• Train ER Techs to draw blood • Change staffing model to
ensure ER Tech
on shift can draw blood • Create Power Plans in RAVEN • Train
Triage RN on new power plans
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Current Results Month Total Pa+ents Average
LOS Door to Bed Time in
Minutes
September 1,969 2:45 54
October 2,002 2:00 37
November 1,749 1:45 35
December 2,005 1:44 30
January 2,053 1:47 40
February 1,906 1:37 39
March 2,153 1:26 36
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Quyana
Questions?
