Urgent Matters Learning Network II
February 2010—Issue brief from Robert Wood Johnson Foundation
Background
Urgent Matters is a national initiative, funded by the Robert Wood Johnson Foundation, dedicated to finding, developing and delivering strategies to improve patient flow and reduce emergency department crowding.
The Urgent Matters Learning Network I began in 2002 as a 10-hospital collaborative learning network that produced research on patient flow measurement and improvement and a series of practical management tools to address issues related to ED overcrowding.
Urgent Matters Learning Network II, which was launched in November 2008, is an 18-month project to advance the spread of promising practices to a wider audience and variety of hospitals. Urgent Matters is now working with the U.S. Agency for Healthcare Research and Quality and HRET. It is housed at George Washington University School of Publish Health and Health Services.
Goals
Researchers from HRET will document the experience of the hospitals as they implement diverse patient flow improvement strategies. Specifically, the study will address the following questions:
- What are the facilitators and barriers to the adoption of patient flow improvement strategies?
- Are patient flow improvement strategies associated with reductions in ED crowding and improvements in clinical care?
- What are the monetary costs and benefits associated with the implementation of patient flow improvement strategies?
Participating Hospitals
Good Samaritan Hospital Medical Center, West Islip, N.Y.
437 beds
Not-for-profit, suburban, teaching hospital
Problem: Nearly half of ED patients are triaged to ESI 3. This group has the highest percentage of patients who leave without being seen and wait the longest to be seen by a physician.
Strategy: MidTrack: The Solution to the ESI III Conundrum-For certain ESI III patients, the team will:
- Utilize a physician in triage to expedite evaluation and initiate treatment; and
- Use unoccupied space in the ambulatory surgery unit to receive patients post-triage and provide care (by a non-physician provider) until the patient is admitted or discharged.
Hahnemann University Medical Center, Philadelphia, PA.
640 beds
For-profit, urban, teaching hospital
Problem I: The current triage system is inconsistent and unreliable for accurately evaluating patients.
Strategy: 5 Level Triage-Implement the nationally-recognized, 5-level ESI triage system.
Problem II: Patients are left in the waiting room for extended periods are more likely to leave without being seen.
Strategy: Open Bed System-Patients will be directed immediately to an open bed, when available, for triage and registration.
Problem III: Inconsistent resource allocation in fast track area results in high rates of left without being seen.
Strategy: ED/Inpatient Report Tool-Fast track will be staffed by a full-time nurse practitioner and nurse. Fast track will have dedicated beds to be used only for fast-track patients.
St. Francis Hospital and Health Centers, Indianapolis, IN
230 beds
Not-for-profit, suburban hospital
Problem: Long lengths of stay lead to patient dissatisfaction and patients who leave without being seen. The registration process is lengthy and variable. Also, the time a patient spends in triage varies from nurse to nurse.
Strategy: Standardized Triage Process-The team will standardize the registration process by providing labels and armbands, using a tracking board and implementing bedside registration. Triage will follow a best practice policy to complete triage in 3 to 5 minutes.
Stony Brook (N.Y.) University Medical Center
540 beds
Public-owned, suburban, teaching hospital
Problem I: Long waits for specialty consults in the ED.
Strategy: Consult Process-A new protocol for initiating and completing specialty consults will be implementing by the team and monitored by the ED clerk. Consults will be monitored and feedback will be provided regarding compliance to the new protocol.
Problem II: Patients with low-risk chest pains are admitted to the hospital, occupying limited hospital beds, thereby delaying other patients from occupying the beds.
Strategy: CT coronary angiogram-Patients with chest pain receive a CT coronary angiogram. Patients not experiencing arterial blockage will be discharged from ED.
Problem III: Patients with abdominal pain experienced long waits to see an ED physician due to delay in ordering tests and labs.
Strategy: Advanced Protocols-Patients with abdominal pain have their blood drawn, labs ordered, medications administered and oral contrast initiated by a registered nurse, unless certain contraindications apply.
Thomas Jefferson University Hospital, Philadelphia, PA.
765 beds
Not-for-profit, urban, teaching hospital
Problem: Fast Track patients have long lengths of stay.
Strategy: Fast Track Improvement Initiative-There will be a dedicated team to staff the Fast Track and supplies will be consistently accessible.
Westmoreland Hospital, Greensburg, PA.
301 beds
Not-for-profit, rural hospital
Problem: Patients experience significant delays after bed assignment.
Strategy: ED/Inpatient Report Tool-Develop, test and implement a fax sheet report that standardizes communication about between the ED and inpatient units.
Research
HRET researchers are tracking the progress of the hospitals through:
- Site visits;
- Telephone interviews;
- Review of performance data; and
- Monthly progress reports.
Findings will offer insights on patient flow improvement strategies, including the costs and benefits. This information will provide useful guidance to other hospitals as they consider the adoption of ED crowding and patient flow initiatives.
Six case study reports will be available here in February 2010.
Partners
With funding from the Agency for Healthcare Research and Quality, The Health Research & Educational Trust, an affiliate of the AHA, recruited six hospitals to participate in Urgent Matters Learning Network II.
Study Contacts
Megan McHugh, Principal Investigator: 312-422-2634, mmchugh@aha.org
Kevin Van Dyke, Investigator: 312-422-2641, kvandyke@aha.org
Juliet Yonek, Investigator, 312-422-2644, jyonek@aha.org
About HRET
Founded in 1944, the Health Research & Educational Trust is a private, not-for-profit organization involved in research, education, and demonstration programs addressing health management and policy issues. An affiliate of the American Hospital Association, HRET collaborates with health care, government, academic, business, and community organizations across the United States to conduct research and disseminate findings that shape the future of health care. For more information about HRET, visit www.hret.org.
About Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation is the nation’s largest philanthropy devoted exclusively to health and health care in the United States and is located in Princeton, N.J. It seeks to improve the health and health care of all Americans specifically; how it's delivered, how it's paid for, and how well it does for patients and their families. The Foundation creates leverage for change by building evidence and producing, synthesizing and distributing knowledge, new ideas and expertise. The Foundation harnesses the power of partnerships by bringing together key players, collaborating with colleagues, and securing the sustained commitment of other funders and advocates to improve the health and health care of all Americans.
About AHRQ
The Agency for Healthcare Research and Quality (AHRQ) is the nation's lead federal agency for research on health care quality, costs, outcomes, and patient safety. AHRQ is the health services research arm of the U.S. Department of Health and Human Services (HHS), and is home to a variety of research centers that specialize in major areas of health care research.
About GW
Urgent Matters is located at The Center for Health Care Quality in the Department of Health Policy at The George Washington University Medical Center School of Public Health and Health.
The Center for Health Care Quality (CHCQ) has as its principal area of research and scholarship the quality of health care for all Americans, with a particular focus on health care equity and vulnerable populations. The Urgent Matters Team directs Learning Network II activities and coordinates the provision of technical assistance (TA) to participating hospitals.
