Improving ED flow

Specialties Emergency



I'm new here and looking for some advice regarding ER flow and throughput. Before I begin a little bit about me and the facility I work in. I've been in the ED area for 5 years and nursing 2 of those years, I work in a level 3 trauma center that was a level 2 until recently but we still see the same high acuity patients but now we just fly or transfer by ground after stabilizing. Within the last 1-2 years we have seen an influx of patients and within the last 2 months a local hospital has closed and were seeing maybe 30-40% more patients. I work weekend night shift 7p-7a and at shift change dayshift tells us it was calm all day until just before y'all got here. ED wait times have gone from 2-3 hours to 6-7 hours some nights. We're not always staffed appropriately but that's always been the case and probably always will be. At night we have 2 physicians and 2 mid levels with full staffing we maintain a 30-34 bed ER until 10 or 11pm then that number drops to 13-16 beds due to staffing and just 1 doc and 1 mid level. Nurse to patient ratio is 1:4 generally. For admissions we have 1 hour to get them out of the ED which is usually done within 30 minutes anyways. We're all moving as fast as we can and yet we're still behind and I would like to know how the flow at your facility is and what has helped or hurt the pt flow. I'm looking for ways to better improve flow but I'm not really sure what more we could do I feel like we all do a good job and we also have a quick care side of the ED that lower acuities are sent to that can be treated and streeted quickly but that closes at 2300. Thanks you!

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

There are two things that I have seen really help in my 13+ years of ED - having a provider in triage who does an MSE and sends non-emergent patients away, or at least having them go to a fast track that is truly fast. The second is a discharge waiting room with a dedicated discharge nurse.

We have a fast track that has 1 nurse and 1 mid level but it closes a 2300, and a discharge area that has a nurse is a good idea. Thank you so much

You'll need to get some solid data to find your true bottle neck(s), e.g. door to doc, door to room, door to dispo, etc. Unfortunately, the ED is becoming something we treat like a patient in and of itself and we rush patients through in order to see more, faster. If you can audit your EMR for these metrics, you'll have an easier time figuring out if it's a provider staffing issue, a nurse staffing issue, a transport issue, an inpatient staffing issue, etc.

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