INTRODUCTION
Emergency Department physicians and staff are delivering services to patients with higher acuity and an increased need for hospital admission. In growing healthcare markets that have reached inpatient bed capacity, turn-around-times for the admitted patient is prolonged. These admission delays create severe bottlenecks in the Emergency Department. While many initiatives address efficiency within the Emergency Department, this presentation will focus on efficiencies within the inpatient environment as well. Projects, such as the creation of a discharge service area, bed tracking technology and the appointment of a bed allocation director, will be discussed.
LEARNING OBJECTIVES
At the end of the session the learner will be able to:
Understand the organizational circumstances that would support the efficiency initiation.
Understand and apply the steps in implementing a discharge service area.
Understand how information technology can improve turn-around-times.
Understand the role and functions of a bed allocation director.
DISCUSSION
Discharge Service Area
The discharge process is a major bottleneck to bed availability and is influenced by a wide range of care processes. One of those bottlenecks is the delay experienced in getting the patient home. The discharge service area is a location for discharged patients who have no immediate transportation home. This move creates capacity and continued care for the emergency department patient until the patient can be transported home.
Bed Tracking
Turn-Around-Times for the availability of a clean room can be reduced by the application of information technology. Presently, once the patient is discharged from a room, multiple phone calls must be made to locate a housekeeper for status room availability. This current process is inefficient and creates delays in getting the emergency department patients to a bed. Information technology can reduce turn around times for these events.
Bed Allocation Director
In March of 2000, the Administration of Orlando Regional Medical Center established the position of a Bed Allocation Director. The position was established at the urging of the Medical Staff Leadership. The job description required the person serving in this role to be a physician. In the newly defined capacity, the physician would oversee the entire admit and discharge process. The Bed Allocation Director assists in identifying and facilitating appropriate patient transfers and discharges with the goal of providing more efficient utilization of bed resources. The Bed Allocation Director is also responsible for making recommended improvements to the bed flow process whenever opportunities are recognized. Inserting a physician into the role was deemed essential because of the peer status and previous experience with nurses trying to expedite flow. Our experience shows the value of naming a Bed Allocation Director.
LESSONS LEARNED
A. Knowledgeable lessons learned:
1. Reduce large scale improvement initiatives into smaller, more easily implemented projects.
2. Understand and manage the psychology of change.
3. Create the appropriate planning and implementation item(s).
4. Identify how the improvement will be measured. Gather baseline date and communicate changes (good and bad).
5. It’s always more complex than you thought.
6. Look and listen. Observe flow in an unbiased manner. Listen to those delivering care.
7. Peer to peer relationships are important.
8. You must have a product champion.
9. Sandbagging is not the only reason beds aren’t available.
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