Category: ED Process

10 Commandments for Great Patient Flow

http://blog.cachinko.com/

Follow these rules to improve patient flow, quality, and efficiency.  We made most of the list in a recent ED meeting, but it applies anywhere patients present.

1.  Add value for patients first, always, and without compromise.

2.  Never make patients wait unless it adds value for them.

3.  Triage means sorting, not primary nursing assessment (see 1 and 2 above).

4.  Time is Quality for most care.

5.   Nurses and physicians must pull in the same direction at the same speed: ED team = 2-horse chariot.

6.  Professionals must do what they do best: RNs do RN work, not clerical work.

7.  Remove or unload bottlenecks.

8.  Always design parallel processes, not sequential.

9.  Design for unlimited capacity; you cannot turn people away.

10.  Patients need humanity with every encounter, especially when ‘there’s nothing wrong’.

Do you have any to add?  Please share them in the comment section.  Thanks!

(image credit: http://blog.cachinko.com/)

Patient Flow into Buckets or Patient Flow into a Funnel?

bucketsNurses and doctors think patients belong in buckets.

Not literal buckets; buckets of care: primary care bucket, emergency medicine bucket, inpatient bucket…

How do we know providers believe in a bucket concept of care?

They tell patients they’re in the wrong bucket!

They tell patients to get out of the bucket!

They tell patients to go to a different bucket next time they need care.

Hilton hotels suggests staff should be empowered to handle ANY issue that arises for guests during their stay.

What happens in healthcare?

Sorry, ma’am.  You’ll have to go somewhere else for that.

Sorry, sir.  I don’t have time to discuss that with you.  The ED isn’t the place for that kind of problem.

Subtitle:  And don’t come back next time!

Funnel of Care

Patients should seek care where THEY choose.  How they choose and how we can help them make a great choice will be discussed in another post.  For now, once patients present with a concern – no matter where they present – we should be prepared to help to whatever extent we can.  Sending them away with a dismissive, “This isn’t an emergency” is unacceptable.

The funnel starts where patients choose to access care.  The funnel continues to more and more specialized care until patients get what they need.

With bucket-thinking, we expect patients to make their own clinical judgment.  Then, we berate them for poor clinical judgment:

“Why didn’t you go see the family-doc/walk-in-clinic/anywhere-else?”

But without clear, available access, patients are forced to attend the ED.  EDs refer patients to their family docs for follow-up far more than family doctors refer to the ED.  Referral patterns have reversed.  We could make the ED a referral only facility like an ICU – no entry without a referral letter.  Family Docs and clinics would need advanced access, longer office hours, basic resuscitation equipment…

System issues force patients to seek care wherever they can get it.  It’s our job to help them when they get there; not send them away.

What do you think?  Would you want your family to be sent away from the ED?  Is that safe?  Is it good customer service?  Click Leave a Reply or # of Replies below.