Getting patients in emergency to an
inpatient bed faster
Getting patients admitted from the emergency department (ED) to a bed on the units as quickly as possible is a top priority at The Scarborough Hospital, and it shows in the numbers. In fact, it will take less time to get you to a bed than at most other hospitals in the province. In Ontario, it takes on average 30 hours to get patients from the ED to an inpatient bed. At TSH’s General campus, it takes an average of 26.4 hours, and the Birchmount campus is right at the 30 hour provincial average.
“It’s important to get patients up to the unit when they are admitted,” says Denise Edman, Patient Care Manager, Emergency and Urgent Care. “In the emergency department, our expertise is in dealing with emergencies. Admitted patients need the expertise of the staff on the inpatient unit. It’s all about getting our patients to the right place, with the right care by the right professional.”
The numbers have improved over the last six months, and it’s due to a few initiatives in both the emergency department and the inpatient units.
The first was an initiative TSH developed with the CE LHIN Pay for Performance called the Mobile Admission Team (MAT). It consisted of one ED nurse, one inpatient nurse and one Team Attendant.
“This team really worked together to facilitate moving patients up to the units,” says Jemini Cheriyan, ED Charge Nurse. “When a patient was admitted, this team would ensure everything was in place to move the patient, such as making sure reports were ready, giving meds and doing VRE/MRSA swabs. Then if necessary, MAT would go up to the unit and make sure the bed was ready for the patient.”
Jemini says the MAT really set the ED on its way to seeing improved numbers.
But the MAT was a short-term initiative, and the ED didn’t want to lose the gains they had made during this time. So they formed a group that consisted of ED nurses, and nurses from Tower 9, one of the inpatient units. Denise Tanner, Team Attendant, had been a part of the MAT and played an instrumental role within this new team.
“We got together to identify the issues, build relationships, facilitate the flow of patients and improve the report sheet,” says Tanner. “One of the key things was to give people more accountability. So we developed the ‘3 Fs of Flow’, fax, fone (phone) and fifteen, to get things moving and remove barriers.”
The goal is to get an admitted patient to a bed on a unit within 15 minutes. Once the bed is ready on the unit, the ED nurse will first fax the paperwork to the unit. Next, the nurse will phone the unit to ensure the paperwork was received. And last, the nurse will ensure the patient arrives on the unit within 15 minutes of the phone call. “We’ve seen improvements in our wait times since we implemented the “3 Fs of Flow’,” says Edman.
A big part of the success has been the involvement of the inpatient units. In addition to the collaborative ED/Tower 9 group, there was a Rapid Improvement Event (RIE) designed to bring together front-line workers to talk about what barriers existed and what could be done to plan and predict capacity rather than just reacting to find the required beds daily.
The RIE was led by Nancy Veloso, Patient Care Director, Medicine/Specialized Geriatrics, Laura Kane, Patient Care Manager, Inpatient Medicine and Alfred Ng, Director, Innovation & Performance Improvement and focused on being proactive instead of reactive.
“The RIE gave a greater sense of accountability to the team,” says Nancy. “Because of the team’s suggestions, we have now implemented a daily bed management process to support unit level predictive discharge planning and corporate decision making around patient flow. The reality is that admitted patients in the ED belong in the unit, not in emergency. So we need to do what we can to bring the patients up to the unit where they will receive the care they need.”
So far these initiatives have been successful, and it’s evident in the numbers. Patients are getting to the beds faster where they can receive the specialized care they require.