Patients leaving the emergency department before care is rendered continues to plague emergency departments (ED) across the country, cascading downstream affects to the rest of the healthcare organization. Prior to the pandemic, Penn Medicine Lancaster General Hospital averaged approximately 1% of patients left without being seen (LWBS); national benchmark is approximately 2%. During fiscal year 2022, we saw a significant rise in the metric; reporting 4-5% on a monthly basis. We focused on implementing measures to impact the measure due to our dedication to our community and response to local competitors within the market. We focused on three areas to improve: 1) more efficient discharge process (goal: by noon) and daily census management, 2) expanded urgent care and primary care practice hours to meet the demand of our lower acuity population, and 3) physical footprint improvements of the organization.
Several measures were implemented to drive success for this project. First, we put in place a provider triage initiative within the waiting area which included expanding hours and redesigning workflows. Daily census huddle dashboards were created to improve transparency of data in real time to all operational leaders. The visibly of the daily goal kept all disciplines aligned to the common purpose of increasing patient flow efficiencies and decreasing LWBS. In order to improve throughput, we implemented a new workflow called “15 and go.” The initiative focused on giving the ED a push/pull process when transferring patients to the units. The floor nurse would review the patients’ story within 15 minutes of being alerted to the order for transfer. The nurse can note in the electronic medical record (EMR) that he/she has reviewed and has no further questions about the patient. A green check mark notification will show for the ED staff alerting them to schedule transport. Our discharge readiness process has been revamped with new workflow collaboration with case management. New milestones were created to allow the process to be more transparent and seamless. In addition, we created a dashboard for quick, real time visibility on each patient’s milestones. Lastly, we created a unit called the transitional discharge unit (TDU) to aggregate patients who are medically stable for discharge but encounter barriers with placement. Using an existing med/surg unit, we created an algorithm for specific patient transfers. We created a new transfer order set to minimize unnecessary tasks for these medically stable patients (example: vital signs every 4 hours).
Through the work of these initiatives, we have been able to reduce our left without being seen metric back to 1.07% and increase patient throughput.
After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.