Reducing Turnaround Time for Fast Track Emergency Department (ED) Patients – Grady Health System; Atlanta, Ga.
Decrease Fast Track throughput in the ED.
The Fast Track service allows patients with acute but non-life-threatening conditions to be treated more quickly and then released. This system is designed to improve the efficiency and decrease the waiting time in the ED when the greatest numbers of people seek emergency treatment. Staff created a highly visible system to sort Fast Track patients by status and indicate what type of services each patient required. In addition, the role of the mid-level provider or nurse was altered to include a more active role in making sure patients receive needed tests.
By implementing the new system, Grady reduced its overall Fast Track throughput by more than two hours and increased productivity by one-third. The changes also decreased the average time from arrival to bed placement by more than 50 percent and decreased the average time from bed placement to initial exam by 19 percent.
Grady Health System
80 Jesse Hill Jr. Dr. SE
Atlanta, GA 30303
P: (404) 616-1000
From the C-Suite:
When we started this process, patient satisfaction was at an all-time low when it came to wait times and the perception of care. We knew that not only did we need to implement streamlined procedures, we also needed the changes to help improve patient satisfaction.”
Leon L. Haley, Jr., M.D., M.H.S.A., F.A.C.E.P.Chief of Emergency Medicine
Grady Health System is a licensed, 1,047-bed, 700-operational-bed facility located in Atlanta, Ga. It includes 88 acute ED beds as well as seven CMU beds.
Grady began by adopting and testing the changes in a pilot project over a two-week period.
Leon L. Haley, Jr., M.D., M.H.S.A., F.A.C.E.P.
Chief of Emergency Medicine
Deputy Senior Vice President
P: (404) 616-6419
Long wait times and an inefficient admissions process are problems that busy emergency departments often face. These problems can lead to long wait times for Fast Track patients.
At Grady, waiting times in the ED reached 10 hours for Fast Track patients, and it was unclear how many patients were waiting to be seen at one time. To combat the problem, a team led by the chief of emergency medicine implemented a highly visible system to sort Fast Track patients by status and indicate what type of services each patient required.
Grady first created the following separate boxes to indicate the patient's status: a) ready to be seen, b) requiring pre-assessment and c) requiring diagnostics. This effectively gave the Fast Track staff “ownership” of those patients waiting to be seen and provided a visual cue indicating which patients needed what type of services.
Next, Grady altered the role of the mid-level provider or nurse responsible for patient assessment in order to change the screening process for those patients potentially needing ancillary tests. This new role required the mid-level provider or nurse to take a more active role in making sure the patient received the ancillary tests needed. In addition, Grady created new standardized procedures and then educated the staff.
These changes were instrumental in decreasing the average time from arrival to bed placement and the average time from bed placement to initial exam, ultimately leading to increased patient satisfaction.
Advice and Lessons Learned:
The cost of implementing the changes, which included increased training for staff and outreach efforts geared towards patients, was minimal. The new system reduced Grady's overall Fast Track throughput from five hours and 40 minutes to three hours and 31 minutes—a 38 percent reduction. Productivity increased by 33 percent. By adopting a series of changes that were tested in a pilot project over a two-week period, Grady decreased the average time from arrival to bed placement from three hours and 39 minutes to one hour and 34 minutes—a decrease of 57 percent. In addition, the average time between bed placement and initial exam decreased from 43 minutes to 35 minutes—a 19 percent decrease.