IMPROVING CARE OF SUBACUTE PATIENTS IN THE EMERGENCY DEPARTMENT
This was a project that our department undertook in 2007. Collaborating with colleagues from our ED, including; Andrea Ennis RN, George Paraghamian, Helen Richard RN, Tim Rutledge MD, Susan Woollard RN - we recognized that we were doing a failry good job at caring for our sickest patients and our ambulatory patients. However, the patients in the middle - those with abdominal pain, renal colic (often CTAS 3) were having extraordinary lengths of stays in our ED. So our ED undetook a "Kaizan".
Kaizan (Japanese for “continuous improvement”) is a methodology used in the workplace for applying rapid process improvement. A Kaizen was held in March 2007 to address the care of patients triaged to the subacute area of the ED. The purpose of this study was to evaluate if the implementation of a new process in the subacute area decreases the length of stays for patients.
From February 26, 2007 to March 2, 2007 members of the North York General Hospital ED (nurses, physicians, support staff) participated in a Kaizen event to address the care of patients triaged to the subacute area. The process involved analyzing all aspects of care for these patients from registration to discharge. As a result, a rapid assessment zone was created utilizing 5 existing rooms in the subacute zone of the ED and an adjacent waiting area. Patients were placed in 1 of 4 assessment rooms only for assessment or specific treatments by the physician and/or nurses. Otherwise, patients remained in chairs in the waiting area of this zone. A treatment area with reclining chairs was established for patients requiring ongoing treatments (IV’s, analgesia). Patient subsequently admitted or requiring a higher level of care were transferred to another area of the ED.
Utilizing the Emergency Department Information System (EDIS) we retrospectively evaluated all patients triaged to the subacute area for 120 days prior and after the implementation. Primary endpoints included; length of stay (LOS) of patients, time to be seen by a physician (time to MD) and patients leaving without being seen by a physician (LWBS).
In the 120 days prior to the rapid assessment zone implementation 5203 patients were seen in the subacute area with an average LOS of 9.3 hours. The time to MD was 2.9 hours with 1333 patients LWBS. In the 120 days after implementation of the rapid assessment zone, 7102 patients were seen in the subacute area (36.5% increase) with an average LOS of 6.1 hours (34.4% decrease). The time to MD was 2.6 hours (10.3% decrease) with 1237 patients LWBS (7.2% decrease).
Implementing a rapid assessment zone in the subacute area of the ED has significantly decreased LOS of patients while increasing the number of patients seen in this area.