The Maximally Efficient and Optimally Effective Emergency Department by Vukmir Rade B

Author:Vukmir, Rade B.
Language: eng
Format: epub
ISBN: 978-0-7618-4701-4
Publisher: University Press of America

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You will learn something new everyday.

The “Team Approach” should figure prominently in the operations program of the best emergency departments. The program begins internally, with all ED providers contributing in a positive way to improve the quality of patient care. This concept extends to other departments, as the ED can often drive efficiency of related units such as telemetry and intensive care units (ICU).

Remember, the ED is usually the epicenter of the hospital admissions process, often with 50 – 75% of patients admitted through the ED proper. For this reason, it is crucial that the entire hospital to recognize this team concept. The hospital admission wards and ED have the same staffing and efficiency problems as well, but the ED must retain the flex capacity to actually deal with the “true emergencies,” as well as minor inconveniences.

Instead of the “Push Approach,” where patients need be “forced” on the floor staff, a more useful paradigm would be the “Pull Approach,” where the floor staff strives to fill the available beds with waiting patients. This approach is established by a well-designed incentive program to reward proactive admission behavior on the part of the floor nursing staff.

My suggested approach, the “Flex Admission Program,” utilizes an admission nurse who is allowed to flex down when the work is complete when her patient cohort is admitted. The “admission” part of the admission process is often most work-intensive while the back-end care responsibilities may be less. This division of responsibility is attractive to different providers. Some providers, therefore, like the nature of the high-intensity admission process, knowing full well that they can leave the shift early. Others like the more routine maintenance care and would be willing to stay for the pre-established shift length with a lower intensity work requirement.

This “Flex” model may utilize two 1:6 (nurse:patient) care FTEs. The admission nurse can process 4 – 5 admissions and then depart, while the maintenance nurse may provide custodial care to 7 – 8 patients at a more leisurely pace. This approach uses the same resources and financial expenditure to care for the same patients, but also improves employee satisfaction.

The potential to create staff division and discord is to foster an environment where administrative personnel are not encouraged to perform clinical activities when needed. It is crucial that supervisory staff maintain their clinical skills. This periodic patient care contact allows one to maintain clinical skills, staff appreciation, and respect. This allows one to manage clinical and administrative dilemmas “down” as well as “up” effectively.

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