UDI is an average care facility, which averagely receives 12,000 patients annually. Among these, 1500 are admitted in the emergency department. Owing to its critical care nature, Emergency Department (ED) require effective and efficient processes with high care quality. The admission process include various steps that ensure quality care is provided. Based on current evaluation, UDI has determined lack of smooth flow of its processes and many delays. As part of mitigation data was collected through observations and service encounter reports to determine the process flow in the hospital and for the development of more efficient hospital processes.
UDI Process Flow
UDI ED processes starts with a pager alerts with ‘Bed Ready’ and is concluded when the patient is escorted from ED and out of Centricity. A Charge RN is paged with the ‘Bed Ready’ alert. he/she checks for the A sign on the whiteboard that shows that demonstrates the patients readiness for admission. Once the care is through at the ED, the Primary RN finishes the paperwork at the Centricity. The printed materials are then sent to various hospital units with the information of the patient and other necessary treatment data. Finally, the Primary RN informs ED tech to transport the patient out of ED, and incase the patient is sent to pilot room, the transporter is informed. The Primary RN then finishes patient chart, he/she cleans the bed for the next patient and readies the area for a new patient. The patient exit the Centricity and is removed from its census. The entire process consumes many resources such as time, human resources, and other hospital resources.
A series of steps was conducted to determine the inefficiencies and come up with means of improving UDI process flow.
- Conducting a data collection pilot
- Performing time studies
- Smoothing staff collected time studies
- Executing a literature search
- Pulling past data
- Developing a value stream map
- Determining Critical Path
- Developing Pareto chart
Process Flow Challenges
The data collected from UDI demonstrated delays in long average admission time from the time bed is set to be ready to the time patient exit ED. The process involved many stopovers and unnecessary process bottlenecks. Additionally, there was confusion human resource allocation in some critical areas.
The process include:
- All adult admissions including those in the observations unit
- All admission process steps from bed ready to patient exit
- Areas not included include:
- Discharges/expired patients
- Pediatric patients
- Left-Before-Exam patients
- Process before ready page
- Process after ED exit
Mitigation measures have been employed to come up with the strategies UDI is facing.