Hospital makes ER improvements
PRESQUE ISLE — The Aroostook Medical Center’s emergency department has made significant progress with enhancements that began last summer to improve the patient experience, strengthen security, and utilize the latest technology.
“When we started making adjustments to how we operate last summer, we knew that it would take some time to get everything in place,” said Daryl Boucher, director of emergency services. “Feedback from our patients shows that all of the little things we’ve done over the past several months are really starting to add up. We hope that the changes we are working on now will continue to make a difference.”
According to Boucher, efforts have been made to improve the flow of patients through the department and achieve greater efficiency. One of the most successful changes the department has made is direct bedding.
“With direct bedding, patients walk into the waiting area, and after a brief conversation with the central registration representative, are immediately brought to a patient room whenever possible,” he said. “We focus on getting the patient into a room, assessing his or her condition, and beginning care. When direct bedding is not possible due to high census, care and diagnostics can still be started sooner.”
Flow through the department, timeliness of care, and security will also be improved as a result of renovations planned for the next six months. The entire entrance will be changed, more efficient workspaces will be created for staff, and the waiting room will be overhauled.
“This reconfiguration will permit better triage of patients and enhancement of the fast track processes, which allows us to provide faster treatment to patients with less serious medical concerns,” said Boucher. “We can improve how patients and staff move through the department and ensure that everything is set up to help us achieve our most important goal: providing timely, quality care whenever someone comes to us with a medical emergency.”
The department’s ability to meet this goal was tested in January when staff handled a large spike in the number of people coming to the hospital with flu-like symptoms. In response to the high volume, TAMC took several steps to free up staff and space in other areas of the hospital to help ensure that the emergency department had everything it needed to deal with the influx of patients. The day surgery department became a temporary extension of the emergency department, staff from the operating room, day surgery, and recovery room helped take care of emergency department patients, and non-clinical staff worked extra hours to replenish supplies.
One of the more difficult parts of dealing with the surge in patient volume was determining when the emergency department could operate normally and when it was necessary to request support from other departments. This is because there are many factors that have an impact on the emergency department’s resources including the number of patients arriving for care at any given time, how sick they are, and how many need to be admitted to the hospital.
Although the response to the surge went very smoothly, the lack of real-time information required staff to work harder to collect the data needed to make decisions. An upcoming technology upgrade will help make this process easier in the future.
“We will begin using a color-coded electronic bed management system to help us determine how to proceed when volume rises quickly,” Boucher said. “Green means we’re at a normal status, yellow means that we may need to make some adjustments to our operations in response to high volume, and red tells us we need to act immediately.”
During the surge, staff learned that in busy times, it is important to get patients who need to be admitted to the hospital into a bed on one of TAMC’s inpatient units as quickly as possible. Currently, it can take five or six calls to get an admitted patient into a hospital room. In the coming weeks, the process will become much smoother. Several teams comprised of hospital employees met in September to analyze the process, and soon the implementation phase will begin. The ultimate goal is to quickly identify which patients need to be admitted, and to begin the admission process immediately.
“The emergency department nurses and the nurses from our inpatient units will be working more collaboratively to get our patients admitted and into a hospital bed,” said Boucher. “The nurses will spend more time together talking to the patient, and the handoff between the emergency department and inpatient units will occur at the bedside with the involvement of the patient and family.”
This change, as well as many of the others being implemented, has required more flexibility from staff, which is something Boucher has emphasized over the past several months.
“This is an amazing group of professionals,” he said. “They have been willing to try new processes and implement the ones that are best for our patients. Our CNAs are taking on new tasks. We’re doing block room assignments for nurses. Instead of nurses having patients at both ends of the department, they are assigned a block of rooms with a provider. It has really streamlined the ordering of tests and has reduced the amount of time they walk from place to place.”
Another part of providing timely, quality care is ensuring the safety of patients and guests, and as a result, TAMC has made changes to improve security in the department. The on-duty security guard is now stationed in the department, and when renovations are complete, the guard will be positioned in a more visible location close to the entrance.
According to Boucher, TAMC is considering several other changes that could help take the emergency department from very good to among the very best. The department is expected to implement bedside registration in March, which will enable staff to get all of the information they need from a patient right in the exam room. Registration will soon be handled later in the visit, after a health care provider has had an opportunity to thoroughly assess the patient’s needs.
“The beginning of the visit is a really difficult time to get the registration or insurance information because people are often in crisis,” said Boucher. “They just want us to take care of them or their loved one. This is change that will help us create a more customer service-focused environment.”
Another example of this renewed focus on customer service is the implementation of follow-up phone calls to ensure that discharged patients are improving and are satisfied with their care.
More improvements are planned for the emergency department in the coming months. Nursing staff will benefit from a hospital-wide effort to offer more educational opportunities for nurses. Further enhancements to the department may include an admission/discharge unit, which could further streamline the process of getting a patient to a bed in an inpatient unit.
“There’s nothing brilliant about what we’re doing,” said Boucher. “It’s just a bunch of little things. When combined with the good work our staff has been doing, a few changes here and there become significant.”
