A Rapid Clinical Evaluation Model alleviates emergency department left without being seen and ambulance diversions by decreasing door-to-doctor time. 

The Problem

Because of organic growth, this high volume (80,000+ visits/year), university-affiliated emergency department (ED) developed pervasive problems with overcrowding, lengthy patient wait times, and ambulance diversions. After an adverse event occurred in the waiting area, patient safety was the primary driving force to conclusively solve their overcrowding issues by revamping ED operations.

Our Approach

A quantitative and qualitative deconstruction of the situation uncovered an ED that was well staffed and already had a large Fast Track unit, but was still unable to handle the current daily volume load within the allotted capacity of 45 treatment spaces. Data showed the majority of patients waiting in the ED Lobby were of intermediate acuity (i.e too sick to be seen in the Fast Track, but not sick enough to be rushed to the Main ED). Effectively, this patient population was the largest contributing segment to this ED’s crowding problem and represented the highest proportion of patients leaving unseen.  Interventions would need to account for better space utilization and redesigned processes to care for each individual patient population. 

Recommendations

Primary focus was given to keeping less sick patients vertical, treating them upon evaluation, and utilizing the freed up space for treatment of the intermediately sick population that would otherwise be languishing in waiting rooms.

• Established a Rapid Clinical Evaluation Intake model of care, providing the ability to have most patients evaluated by a doctor or mid-level provider within minutes of patient arrival even at peak-volume hours.

• Established alternative treatment and processing areas to care for low-acuity patients without the need to place them in Fast-Track beds for evaluation or disposition.

• Converted the Fast-Track area into an Intermediate Care Unit; able to promptly receive and treat the intermediate acuity population and markedly reduce the need to use main ED beds to see these intermediate acuity patients.

• Revamped interfaces with ancillary departments to support the new operational ED model. 

• Created shared data gathering and reporting mechanisms visible to the entire organization.

Results

• Door-to-Doctor times decreased by 67% on the first month and reached and average of 19 minutes even as volumes increased to 100k visits a year.

• The rate of patients leaving the ED unseen decreased from 5% to less than 1%.

• Ambulance Diversions decreased by more than 60%.

• More than 40% of non-admitted patients are now able to leave the department within 2 hours from arrival.

• ED patient satisfaction levels have consistently increased to a current ranking within the top national quartile.

To learn more about how Ximedica can support 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.