Category: ED Process

Wait Times Secret for Best in Province ED

Healthcare wait timesIf you want to achieve the best wait times in the province, you need to know your hourly wait times, in minutes.  Averages wait times, or wait times at specific times in the day, will not work.  You need to know how your department functions every hour, down to the minute. (We had the best time to physician initial assessment in 2013-2014 at <1.5 hr 90th percentile.)

 

Clinicians need a thermometer

Managers need an operations report

Board members need a budget

You need hourly wait times reports

Instantaneous Wait Times

To drive change, you need live data, like a thermometer.  Patients benefit when providers change their behaviour based on feedback from data about immediate circumstance.

Sure, yesterday’s information helps, if clinicians can remember what they did yesterday.  Invariably, horrendous cases or surges in volume stick out in our memories from yesterday.  The thousands of banal decisions made that truly impacted performance never get remembered.  They reside in the background of our thinking, safe from examination.

Change happens when data becomes available in the moment.  Hour by hour data can pinpoint who was working at a particular time and what care was being given.

Real time data allows leadership to query performance and address it immediately.

To get the best wait times in Ontario, we had to ask decision support to report hourly waits in minutes.  Hourly reporting supported, or corrected, hunches we had about when wait times lagged.  Once we had the right data, we could start trying creative solutions to improve.

Average Wait Times

‘Average’ causes pain and suffering.  Reporting averages in healthcare is like reporting the average number of parachutes required for passengers jumping out of a plane.

Average wait times, average patient volumes, and average provider work speed mean nothing to a patient standing in line with tearing chest pain.  Leaders should get a bit upset when they hear averages reported, or at the very least, ignore them.

What do you think?  When you ask about wait times, are you getting performance from the last quarter?  Are you asking for the right kind of data?

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(photo credit: carp.ca)

Improve Quality, Efficiency, & Communication with Physician Navigators

executive-assistantEmergency physicians spend more time looking for charts, finding lab reports, and checking if treatments are done, than they do caring for patients.  After continual interruptions from allied health providers, patients, and other physicians, doctors have little time left for patients.

Some say scribes help.    But after trying scribes, we found navigation to be our greatest need, not transcription.

Physician navigators (PNs) do 2 things:

Direct physician-patient traffic

Manage information

They do not:

Make clinical decisions

Give clinical advice

Order clinical care

PNs improve:

Patient experience.

Physician efficiency

Team communication, especially between nurses and physicians.

PNs perform non-medical tasks that MDs do when working without a PN.  They do anything doctors do that does not require a medical degree.  

We use Physician Navigators to

  • Keep informed of patients waiting in all areas of the department
  • Find out which patients are waiting to be seen next
  • Accept and photocopy patient handover lists from the physician handing over —
  • Make sure all these patients are reviewed and looked after by the accepting physician
  • Keep track of all the patients the doctor has seen and when patients are ready for reassessment
  • Obtain chart for “next available MD to see”
  • Access electronic charts; print out reports
  • Prepare chart for MD reassessment: blood-work, x-rays…printed and ready to hand to patients at discharge
  • Update MD data in the ED information system (tracking board)
  • Page and receive specialist phone calls
  • Receive and manage other incoming calls
  • Hold non-critical calls for MD when MD is with a patient
  • Assist RNs locating MD for urgent needs
  • Inform patients about wait times and purpose
  • Direct patients in and out of examining stations
  • Update RNs on MD work plan
  • Receive RN requests for patient reassessment
  • Work with the team (e.g., RN and RT) to gather equipment for procedures
  • Handout patient information sheets and referral forms to patients when instructed by MD
  • Assist with paperwork to ensure proper completion
  • Create handover list at the end of a shift

Physicians Navigators do this, and more, with good humour, a positive attitude, and in a polite, semi-invisible way.  After a few shifts with a PN helping out, physicians never go back.

(photo credit: whatdoesceostandfor.com)

Canada’s Hospitals, NOT Canada’s ERs, missing mark on waiting times, new statistics reveal – The Globe and Mail

The Globe and Mail missed the mark.  Hospitals, NOT Emergency Departments (EDs), leave patients in overcrowded EDs for nearly 30 hours before moving them to an inpatient bed.   EDs do not make admitted patients spend too long in the ED.  Hospitals do.  Hospitals could empty EDs of admitted patients at any time, if they wanted to.

Canada’s ERs missing mark on waiting times, new statistics reveal – The Globe and Mail.

Hospitals choose to leave 15 extra patients admitted in the ED; they could spread them out over all the inpatient wards.  Few hospitals enter the political battle of angering unions by placing extra patients on inpatient hallways, despite the nearly 400 articles published showing that mortality and morbidity increase for every hour admitted patients get warehoused in EDs.

Full Capacity Protocols empty EDs, have been used in Canada, and leave no excuse for exposing patients to the proven risks of long waits in the ED.

When will government change incentives so that hospitals start emptying EDs?