Flow improvement

[RNCEN]

I'm working with a multi-disciplinary committee that includes both department members and several other hospital-wide members to identify barriers to efficient patient care and flow both within the ED and transitioning to the inpatient side. Constraints--- add no FTE's, and we will not be considering any major construction. This project will be several months in duration and is only in the beginning stages.

I'm reaching out to this forum because I think you may have valuable ideas and experiences. I'm curious as to what issues you've encountered in your departments in terms of flow, and what has been done to resolve them. We are identifying time wasting activities/processes in order to better serve our patients. We are a large ED, appx 90 beds, seeing 100K patients/year. We use a bedside triage model when possible, and have 3 acute "pods" a fast track/minor acute area, all with their own providers/PAC's. 2 radiology areas, 3 CT scanners, and several US techs on at any given time. We are also a trauma center, with a large population of elderly falls with anticoagulants.

What time wasters do you have your department...and has anything been done about it?

Thanks for your input!!

[Sassy5d]

Besides the fact that many times, there is a critical patient being worked on while a non-critical patient is waiting to be dispo'd, the biggest barrier I find to admit to removal from ER is the floor.

If I had a shot of vodka for every time I was lectured about door to floor time (we're not dumb, we know what it truly boils down to), I'd be intoxicated every shift I work.

The bed is dirty, although I think it's funny that I can wipe an entire ER room down with sani/bleach wipes in 5 minutes.. The nurse has not been assigned, the nurse is on lunch. The nurse is off the floor, the nurse is in report, the nurse is busy with a patient (again, I know floor nurses are busy), This patient is not appropriate for the floor and we are calling the supervisor, ect.

What have we done about it? There's really nothing to be done about it. This is just how it goes. We've gone up the ladder and nothing changes. I guess when reimbursement plummets, maybe we'll see a change