Clinical Leaders in ED Improve Throughput

    • February 26, 2013

Title:
Driving Emergency Department Improvement With a Dedicated Clinical Team Leader

Result:
Since implementing the Clinical Team Leader position in the emergency department Lakewood’s left without being seen rates have improved from 7.7 percent to 6.8 percent.

Institution:
Truman Medical Center Lakewood
7900 Lee's Summit Road
Kansas City, MO 64139

Profile:
Truman Medical Center Lakewood operates a 20 bed emergency department in Kansas City, Missouri. It sees approximately 32,514 patients a year.

Contact:
Daniel Thompson RN, BSN, CEN, MBA
Director of Emergency Services
(816) 404-7000
Daniel.Thompson@tmcmed.org

Innovation Implementation:
Implementing and sustaining change in any hospital department requires the constant presence of a champion. Without this support, staff often fall back to old habits, disregard new processes or procedures or adapt independently to problems that might arise with a new system rather than working with the team to address them. 

As part of an effort to implement quality and operational improvements, the emergency department (ED) at Truman Medical Center Lakewood identified a need for strong leadership supporting the quality improvement changes implemented during the Increasing Throughput collaborative. Because it was unable to pay for the creation of a full-time quality improvement staff member to do this, Lakewood created the role of “Clinical Team Leader.” The new role is a hybrid nursing position similar to a dedicated charge nurse but with more managerial responsibilities, such as conducting nurse audits and employee evaluations. The Clinical Team Leader has a role providing clinical care as well as in ED management.

Preparing for and implementing the Clinical Team Leader position was relatively simple to do but took careful consideration of who the right candidates were for a position that required both clinical and managerial skills. Many nurses had little experience in leadership roles and needed to be trained and supported in order to be successful. To overcome this barrier the ED leadership worked with Lakewood’s human resources department to either hire the right candidates from outside, or promote from within and give them the professional development knowledge base to succeed.

They also determined that the change initially required having more senior leadership – such as the director of emergency services – available when there was pushback from other team members unaccustomed to the Clinical Team Leader. 

Since the ED’s implementation of the Clinical Team Leader, Lakewood’s left without being seen rates have improved by almost one percentage point, decreasing from 7.7 percent prior to implementation of the clinical leader to 6.8 percent afterwards. This improvement is estimated to have prevented 141 patients from leaving the ED before being seen (from September 2011 and March of 2012). While Lakewood has implemented number of interventions during this time, the hospital is adamant its success was contingent on the support and oversight that the Clinical Team Leader brought to the table.