Like hospitals nationwide, Florida hospitals are struggling with increasing patient volumes, overcrowded EDs, and inefficient processes. To combat these issues, these Florida hospitals have implemented a combination of new technology and creative streamlining measures.
St. Lucie Medical Center in Port St. Lucie, Fla., a Hospital Corporation of America hospital, launched a campaign via TV, radio, and print advertising. The spots provide examples of medical emergencies. “We tried to educate them to the fact that if we tie up beds for non-emergent issues, it makes it difficult for any ED to try to address overcrowding and to have available open beds for true emergencies,” says Jim Kruger, RN, BSN, CEN, director of the ED, which averages 112 patients a day. The campaign has helped decrease inappropriate ED visits by approximately 15%, says Kruger.
A restructure of workflow and staffing at Aventura (Fla.) Hospital, also an HCA facility, helped drop its arrival-to-physician time from over an hour to an average of 13 to 15 minutes. A team consisting of a triage nurse, a medic, and a physician assistant see new patients simultaneously so that vitals can be taken and tests ordered on the spot.
“With the additional PA staffing, we can get less urgent patients out of the ED more quickly and the ED doctors can concentrate on seeing more critical patients brought in by the rescue squads,” says Julie Millar, RN, MSN, director of emergency services. Wireless SpectraLink phones allow staff to communicate with each other.
A restructuring of the ED at Martin Memorial Medical Center in Stuart streamlined the admission process from up to 14 steps to three, dropping door-to-physician time from an hour to 31 minutes. “When we looked at our processes in the eyes of the patient, we realized that we had a lot of processes that were not customer-friendly,” says Dalynn Sotomayor, RN, BSN, MBA, administrative director of emergency services.
Now technicians are stationed in the waiting room, register patients, and perform vitals within 10 minutes, as well as do EKGs on suspected heart attack patients. Predetermined order sets for specific diagnoses allow nurses to expedite assessment.
At St. Lucie, all rooms have computers that provide electronic tracking of patients each step of their visit and real-time status of tests and orders. Patient charts are also maintained electronically. Labs and X-rays are ordered at the bedside through a software program called ePOM from Meditech.
Indian River Medical Center in Vero Beach, Fla., added an electronic patient tracking system called the McKesson tracking board as well as an electronic patient documentation system called Horizon Emergency care that allows floor nurses to review a patient’s history before he or she is transferred to the floor. Door-to-physician time is down to 23 minutes, says Sharon Wolfe, RN, BSN, CCRN, nurse manager of emergency services.
One of the first things St. Lucie did was to create a “subway waiting room,” an area off the ED waiting area that handles overflow patients where assessment and tests can be administered.
Indian River, which averages more than 160 patient visits to the ED daily, created an eight-bed clinical evaluation unit that allows staff to observe patients, order tests, and gather information. “In the past, these patients went to the floor and occupied premium bed space,” says Wolfe.
Indian River also added a fast track unit to handle minor care cases.
“Streamlining the ED should be a grassroots effort that begins with the nurses,” says Kruger. “Our nurses played a critical role in determining where the issues were and developing strategies to streamline the process.”
Susan Meyers is a freelance writer.