Hospitals in pursuit of excellence

Green Dot to Move

The Problem

Advocate Lutheran General Hospital admits 32 percent of its emergency department patients per month on average. With this busy of an ED and such high-volume admission, it is critical that all clinicians and departments prioritize and support the patient through the process.

In its initial state, it was uncertain what priorities took precedence. Each department (ED, clinical bed management (CBM), accepting inpatient units and transportation) worked in individual, siloed functions to make decisions on when and where a patient would be moved. Because of the variation in patient-care practices, it was challenging to know when the nurse or physician was ready to release the patient to move up to the floor.

This uncertainty lead to CBM often assigning and then reassigning patients to a bed on an inpatient unit because either the ED wasn't ready to release the patient, the accepting inpatient unit wasn’t ready to receive the patient or because the virtual bed assigned was an inappropriate match for the patient’s needs.

The Solution

An interdisciplinary rapid improvement events team, comprised of 16 members, examined the current process and offered recommendations. The primary recommendation had CBM assign admissions and transfers to all nursing units. In order to streamline communications in the ED, expedite patient throughout the hospital and synchronize movement between various departments, the following processes were created:

Symbols were created in the First Net, Care Connection of the hospital's electronic medical record system to serve as a visual prompt to indicate the patient was ready to move. The collaboration of three symbols—physician done, nurse done and bed request—serve as a trigger to CBM that the patient in the ED is ready to move. When an ED physician is certain a patient is going to be admitted, they place a "bed request"in the system, finish their patient care and then put a "physician done" symbol in the EMR. In addition to those two symbols, a nurse puts a "green dot or nurse done" in the system, indicating that initial treatments and medications have been started, nursing reports have been given to accepting units, the patient is hemodynamically safe for transport and meets criteria and the patient belongings checklist has been completed.

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