A select group of patients at Peterborough Regional Health Centre (PRHC) will soon find themselves being steered through the admissions process in less than half the time it currently takes.In a bid to make the admissions process better for both patients and staff, PRHC is introducing PEAT, a unique, patient-centered approach to admissions that could bring multiple benefits to the Health Centre and the people who go there for treatment.
PEAT is an acronym for “Patient Express Admitting Team”, a concept standing in sharp contrast to traditional admissions.
In many hospitals, the process of admitting a patient is often described as “fragmented, piece-meal”, fraught with delays, lost information, repetitive procedures and other problems that leave patients and staff alike frustrated and anxious.
It is not uncommon for patients to be kept in limbo for hours as they wait for x-rays and scans to be done, medications to be administered and lab work to be requisitioned.
PEAT is designed to address these problems by streamlining the admitting procedure.
With PEAT, patients coming into the hospital are initially assessed as they would be in a traditional system. But if they meet certain criteria, the charge nurse will use a pager to summon a PEAT nurse for them.
Once approved for express admission, the patient becomes the sole focus of the PEAT nurse, who will spend the next sixty to ninety minutes registering the patient, starting medications, expediting x-rays or scans, requisitioning lab work, administering infection control protocols and initiating planning for the patient’s future discharge. Before the patient arrives on their designated floor, they are fully admitted and ready for further medical treatment.
The criteria for selecting patients eligible for PEAT is simple. Patients must be headed to a clearly defined treatment destination, which in most cases will mean a designated and assigned medical or surgical bed. They cannot be patients “stuck” in Emergency. Furthermore, the patient or a family member must be able and willing to complete a survey designed to improve and develop the hospital’s admission process.
Janice Kaffer, chair of PRHC’s PEAT project, estimates that there are approximately thirty admissions a day through the hospital’s Emergency Department, and about two-thirds of these are medical or surgical patients. This translates to roughly twenty patients per day who might be considered for a PEAT admission. Kaffer estimates sixty to seventy-five per cent, or between seventeen or eighteen of these patients would be eligible for PEAT.
The PEAT team at PRHC hopes the new system will bring several benefits to the busy Health Centre and its patients. The team expects PEAT will reduce a backlog of patients in Emergency, free up nursing hours spent on in-patients, reduce average length-of-stay, produce better adherence to infection protocols, improve relationships between staff in Emergency and Medical/Surgical departments and, most of all, reduce patient anxiety.
“This is a customer-service oriented way of taking patients into the hospital and making sure they feel taken care of. PEAT will play an important role in helping patients understand what the admission experience will be like. We want to ensure their first contact with admissions is a positive one,” says Kaffer.
The impact of PEAT will be measured with patient-satisfaction surveys, feedback from staff, statistics on length-of-stay and data related to staff utilization, done primarily using the GRASP workload tool. A key measure of the unit’s effectiveness will be its impact on the length of time it takes for PEAT patients to be admitted in the units.
Bev Reid, PRHC’s GRASP consultant, says the impact of PEAT will not be felt immediately.
“We will look at how fast patients are coming out of ER, and we will look at drops in staff utilization, but it will take some time for results to show up,” says Reid.
Wendy Fucile, Vice President and Chief Nursing Officer at PRHC, and the sponsor of PEAT, says the Health Centre’s key objective for the new unit is patient satisfaction.
“We want patients to feel better about the admissions process. If we can demonstrate greater levels of patient contentment, we’ll look at PEAT as being successful,” says Fucile. “and it may be the little things that show that. One of the comments I hear from patients, from families, from doctors is that no one knew where the patient moved to. When you follow that sort of thing up, there are any number of staff members who might have done those notifications, but none who expressly had to. It’s scary not to know where someone you love has been moved to.”
The concept of Express Admission Units originated in New Jersey, and initial results there suggest PRHC’s PEAT team have good reason to be optimistic about their new program.
At the Muhlenberg Regional Medical Center in Plainfield, New Jersey, a pilot study of Express Admissions reported increased patient, physician and staff satisfaction; a twelve per cent reduction in patient days; and a decrease in actual length-of-stay compared to expected length-of-stay in eighty-six per cent of the patients in the unit.
PRHC is a pioneer in Express Admissions and Janice Kaffer says she expects the Health Centre to be a leader in the practice. After several months of planning, PRHC plans to take in its first PEAT admission the beginning of December.