Ximedica Implements Team Approach to Care in Emergency Department

Similar to many emergency departments (ED) that suffer from overcrowding, our client’s mid-sized community hospital faced increasing concerns over exceedingly long wait times, patient safety, poor staff workflow, and overall inefficiencies. The hospital ED’s "left without being seen" rate and diversion rate, times incoming ambulances are diverted to other hospitals due to overcrowding, were climbing by the month. This triggered low patient and staff satisfaction scores, concerns about patient safety, and lost revenues. As a starting point, the patient journey was mapped out into three specific intervals:

1.    Initial entry to ED to initial physician assessment (also known as “door to doc” time)
2.    Initial physician assessment to disposition decision
3.    Disposition decision to admission to hospital if necessary

For several reasons specific to this client, the decision was made to prioritize the interval of initial physician assessment to disposition decision first.

Ximedica and hospital staff collaborated to map the clinical workflow involving the interval of initial physician assessment to disposition decision. This included interfacing services such as lab, pharmacy, and hospitalist consults - to reveal inefficiencies, unnecessary delays, work-arounds, and risk-prone elements of the system.   

Key observations included:

• No designated MD/RN/Tech team around any given patient rooms
• Patient room set-up limited ability to treat full range of acuity levels
• Behavioral patients mixed into general patient path of care
• Pediatric unit largely underutilized, consistently re-purposed to the fire-drill-of-the-day
• Staffing utilization misaligned with patient demand
• An overall individual care model with no big picture view of the ED

Our initiative focused on changing the model of care by redefining the existing space and reorganizing staff into teams with aligned roles and responsibilities.

• All rooms divided into specific care teams
• Each care team staffed with a dedicated team of providers
• Patient rooms updated to treat a wider range of acuities
• Behavioral patients relocated to a secure, separate unit
• Charge Nurse acts as “air traffic control” and manages patient flow at the macro level
• Dedicated workstations created to support each individual care team

• Patients placed in beds faster
• More collaborative working relationship between the physician, nurse, and tech on each patient's assessment, plan for treatment, and disposition – resulting in a shorter interval of initial assessment to disposition decision
• Patient safety, flow, and satisfaction enhanced with a team approach that accounts for micro and macro activities in the ED
• Staff confidence in their ability to drive change 

To learn more about how Ximedica can join with your team to achieve adoptable and sustainable workflow improvement resulting in enhanced patient flow and safety, please contact Ximedica’s Director of Healthcare Delivery Solutions, Kristin Simoens, at ksimoens@ximedica.com.