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Originally Posted by rubicon
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What I am saying is the ER is a failure because of management. Indeed there can be more hair raising nights then others but planning is the key.
I worked in insurance we had plans in place for catastrophes. We knew we had to get in and get out fast to meet people's needs.
The problems associated with The Villages Hospital fall on the Board of Directors and management . I feel badly for the employees
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I agree with you to a point, the failure of management is in not CORRECTING the problem. The board is not down in the ER doing the work, but they are responsible for oversight
Each ER seems to have it's own "culture", and as someone put it, I have had "firsthand" experience with 20 or 30 of them. If the people in charge are laid back and have low expectations, it carries through all the staff. Sometimes there are people there for 20 or 30 years that defacto run the show THEIR way, and are reticent to change. This problem came up when I ran the QA committee, was chief of staff and sat on the board, so here is what we did:
1) We designated 5 rooms as fast track/urgent care with a good NP in charge and triaged appropriate cases in that direction.
2) We looked at ambulance arrivals. There are people who call an ambulance for no good reason at all. About 85% of this was because car service cost $5 but the ambulance was free (to THEM, $800 for the taxpayer to fork up). The other 15% was due to the belief they could bypass the waiting room. So we started a policy that non-emergent ambulance arrivals would be triaged to the WAITING ROOM, and usually to urgent care from there, thus removing some incentive.
3) Often there are patients who are getting admitted, but were waiting to be seen by the hospitalist or attending. We made a policy that the attending had 30 minutes to see the patient in the ER, otherwise they would be sent to their floor with just a few holding orders. The floor nurses would bug them from there. This freed up many ER rooms to move patients along.
4) We overrode a nursing policy that stated no patient would be accepted to a floor for 45 min before and after a shift change. This was 4 1/2 hours each day during which no patient could be moved out of the ER. This was accomplished by staggering shifts and mixing in 12 hour shifts for those who wanted them
5) We started much more extensive tracking of ER times, from triage to nursing assessment, physician contact, lab and x-ray being performed and admitting physician writing orders. We put a big LED TV over the ER desk with the initials of each patient in each room, their preliminary diagnosis, and the arrival time. Any time more than 25 minutes passed between steps that room was highlighted
6) we put in loud and annoying call bells in each ER room that could only be turned off from within the room
7) we gave out patient satisfaction forms to every patient and family asking them to be explicit about their experience
8) We identified the slowest and laziest worker on each shift and found them a more appropriate position elsewhere. The message was clearly sent.
Bottom line, within 4 months waiting time was cut in half and was less than the national average, and patient satisfaction went from 4.6 to 8.9 (out of 10).
So it can be done. TVRH ER may have some slightly different problems, but wait time everywhere is related to volume, staffing, and patient flow. So why hasn't this problem been addressed long ago, that's the real question.