By Debra Wood

More and more people are seeking care in emergency departments, leading to crowding and extended wait times that can adversely affect patient satisfaction and outcomes. Many nurses, including ER nurses, have come up with ideas to improve throughput and enhance care.

“Wait times are a very prevalent problem,” said Paula Roe, BSN, MBA/HCM, FACHE, senior consultant with Simpler Consulting, based in Pittsburgh, Penn. “There are many things that can be done.”

Roe helps clients discover waste through Lean principles and thereby reduce ER wait times.

At the end of 2013, ProPublica launched an interactive news application called ER Wait Watcher, using government information to educate people about average wait times at emergency departments (EDs). ER Wait Watcher reports a national average waiting time of 28 minutes before the patient sees a physician.

The American College of Emergency Physicians reported in April 2014 that 46 percent of surveyed members reported an increase in emergency department patients since January 1, 2014. Most respondents, 94 percent, did not believe wait times were the biggest issue facing emergency patients and their ability to access care, however. Interestingly, their top concern was the limited supply of primary care physicians, followed by too many non-urgent patients that might instead be treated in a primary care setting.

Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, president of the Emergency Nurses Association, agreed that a lack of primary care contributes to ED crowding and waiting.

In a recent interview, she pointed out that patients boarded in the ED also stop the flow and lead to crowding. Other people have to wait longer because the ED stretcher is occupied. To solve the problem, Brecher said hospitals must involve the entire hospital in getting patients ready for discharge out, the beds cleaned and the transfers made.

“You have to think of crowding as a hospital problem and not an emergency department problem,” Brecher explained. “It involves an organizational effort.”

Jodi Pahl, chief nursing executive at St. Rita’s Medical Center in Ohio, and the team at St. Rita’s launched a comprehensive communications program to keep all hospital clinicians informed of when patient wait times in the ED increase beyond acceptable levels. Those communications may prompt physicians to discharge patients ready to go home more quickly. As a result of this program, St. Rita’s was able to decrease patient wait times, as well as walk-out rates. Patients wait to see the doctor an average of 34 minutes at St. Rita’s, according to ER Wait Watcher.

Several hospitals have opened fast-track systems to reduce wait time, by getting the “walking well” in and out, Brecher said. She also reported an increase in the use of provider-nurse teams at the initial point of entry. Tests can be ordered so results are available more quickly once the patient enters the ED. Patients with minor ailments can be treated and released.

Charge nurse Steven Kunz, RN, CEN, of Aria Health’s Torresdale campus emergency department in Northeast Philadelphia, reported that reducing ER wait times and improving care are the key focus areas of the hospital’s new emergency department.

“Our strategic group of stakeholders including nurses, physicians and administration, worked together to implement an updated registration system that includes a pivot nurse to help transform triage,” Kunz said.

The pivot nurse greets patients upon their arrival, obtains patient identifiers and vital signs, and performs a rapid assessment to determine the level of need for immediate care. The pivot nurse concept, combined with an expanded treatment area and more rapid evaluation and disposition by the physician, have worked to reduce wait times and improve patient satisfaction, he added.

Penne Marino, RN, and colleagues at Lancaster General Hospital in Pennsylvania described in the Journal of Emergency Nursing in 2014 how a multidisciplinary team established a Bypass Rapid Assessment Triage process. Patients are met by a greeter nurse, who conducts a quick assessment to determine acuity and then places the patient in an appropriate bed. This new system reduced the time it took patients to see the physician and enhanced patient satisfaction. According to ER Wait Watcher, patients are seen by a doctor within 17 minutes.

The University of Kansas Medical Center (KUMC) in Kansas City, Kan., hired a bachelor’s-prepared emergency registered nurse as a flow coordinator in hopes of reducing its wait times. Seamus Murphy, BSN, RN, CEN, CPEN, CTRN, CPHQ, NREMT-P, at KUMC, and colleagues reported in the Journal of Emergency Nursing in 2014 how the flow coordinator decreased length of stay by 87.6 minutes, reduced the number of patients who left without being seen and decreased the number of time the hospital was on diversion. ER Wait Watcher reports an average wait time to see a physician is 34 minutes and more than eight hours for admitted patients to be roomed.

Nurses remain on the forefront of trying to improve throughput and reduce ER waiting times. Roe explained that nurses can assess improvements in three areas: triage, evaluation by medical staff and associated diagnosis and treatment, and then disposition.

“Each phase has its unique opportunities to eliminate barriers, reduce waste and improve wait times,” Roe said. “Nursing and how nurses deliver care is key in process improvement efforts. It’s important they are involved as frontline staff and part of studying the current state, helping to identify barriers to patient flow and understanding the solutions to deploy to make the situation better.”

Source: www.nursezone.com