More and more people are seeking care in emergency departments, leading to crowding and extended wait times that can adversely affect patient satisfaction and outcomes. Many nurses, including ER nurses, have come up with ideas to improve throughput and enhance care.
“Wait times are a very prevalent problem,” said Paula Roe, BSN, MBA/HCM, FACHE, senior consultant with Simpler Consulting, based in Pittsburgh, Penn. “There are many things that can be done.”
Paula Roe, BSN, MBA/HCM, FACHE, senior consultant with Simpler Consulting, said nurses are key to improving wait times.
Roe helps clients discover waste through Lean principles and thereby reduce ER wait times.
At the end of 2013, ProPublica launched an interactive news application called ER Wait Watcher, using government information to educate people about average wait times at emergency departments (EDs). ER Wait Watcher reports a national average waiting time of 28 minutes before the patient sees a physician.
The American College of Emergency Physicians reported in April 2014 that 46 percent of surveyed members reported an increase in emergency department patients since January 1, 2014. Most respondents, 94 percent, did not believe wait times were the biggest issue facing emergency patients and their ability to access care, however. Interestingly, their top concern was the limited supply of primary care physicians, followed by too many non-urgent patients that might instead be treated in a primary care setting.
Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, president of the Emergency Nurses Association, agreed that a lack of primary care contributes to ED crowding and waiting.
In a recent interview, she pointed out that patients boarded in the ED also stop the flow and lead to crowding. Other people have to wait longer because the ED stretcher is occupied. To solve the problem, Brecher said hospitals must involve the entire hospital in getting patients ready for discharge out, the beds cleaned and the transfers made.
Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, said improving ED flow requires an organizational approach.
“You have to think of crowding as a hospital problem and not an emergency department problem,” Brecher explained. “It involves an organizational effort.”
Jodi Pahl, chief nursing executive at St. Rita’s Medical Center in Ohio, and the team at St. Rita’s launched a comprehensive communications program to keep all hospital clinicians informed of when patient wait times in the ED increase beyond acceptable levels. Those communications may prompt physicians to discharge patients ready to go home more quickly. As a result of this program, St. Rita’s was able to decrease patient wait times, as well as walk-out rates. Patients wait to see the doctor an average of 34 minutes at St. Rita’s, according to ER Wait Watcher.
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