Date of Award

Spring 2021

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Doctor of Nursing Practice

Degree Name

Other

First Advisor

Sarah Plante

Second Advisor

Cody Legler

Abstract

Abstract

BACKGROUND: Emergency Department boarding is a well-documented systemic problem across the country. ED-2b, the time from decision to admit a patient to Emergency Department departure, is specified by the Joint Commission as a quality measure for Emergency Department boarding. ED-2b metrics have been a longstanding challenge at this community hospital outside the nation’s capital. The aim of this study was to reduce median ED-2b times by 10% compared to fiscal year 2020 (FY20). To accomplish the reduction in time, a multidisciplinary throughput committee was developed with subsequent action plans designed to improve Emergency Department throughput.

METHODS: The Plan Do Study Act method of quality improvement was used for this project. Several tactics were developed to address a variety of known throughput challenges. Baseline assessment included a review of FY20 ED-2b metrics. These times were used as the comparative pre-intervention data. Literature review queries were conducted to identify tactics to improve hospital throughput.

INTERVENTION: A multidisciplinary hospital throughput committee was developed along with a Plan Do Study Act action plan at the beginning of FY21. Improvement tactics included the standardization of workflows for care transitions, compliance with a telemetry discontinuation protocol, implementation of an early warning predictive model for Emergency Department overcrowding, and an inpatient discharge team. In addition, data was collected during the project period comparing bed request to bed assignment, bed assignment to unit arrival, and inpatient discharge order to depart times. Perceptions of the implications associated with Emergency Department boarding were assessed pre and post intervention.

RESULTS: Eight months after implementing various tactics, ED-2b metrics were reviewed to assess effectiveness. Comparative data revealed a statistically significant improvement in ED-2b median times. In addition, implementing a discharge team demonstrated a 21% improvement in inpatient discharge departures by 1700.

CONCLUSION: Implementing a multidisciplinary throughput committee with engaged participants and leaders, creates a forum for process improvement. By implementing several tactics with key stakeholder, the reduction of Emergency Department boarding time is achievable. Accomplishing frontline engagement supports the success of tactics, improvement of patient satisfaction, and aligns with organizational goal achievement.

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