Faxed Report Form for Emergency Department, Inpatient and Nurse Supervisors

Goal:
Improve patient throughput rates by improving communication between the emergency department (ED) and the receiving inpatient units.

Innovation:
Developed and implemented a standardized form that is filled out by the ED nurse and faxed to the receiving department’s floor nurse as part of the hand off process.

Result:
Westmoreland saw positive results from this strategy. Four months after implementation, they had reduced the median hold time per patient from 130 to 80 minutes, representing a significant improvement in the hospitals throughput rates. The project team also reported an overall improvement in the relationship between the ED and inpatient unit staffs.

Institution:
Excela Health Westmoreland Hospital
Emergency Department
532 West Pittsburgh St.
Greensburg, PA 15601
P: (724) 832-4479

From the experts:
“Utilizing the communications tool and implementing a formal communications strategy helped us make a huge cultural shift in the way the organization thinks about throughput. This formalized communications strategy helped improve communication between the ED and nursing staff as well as elevated coordination and communication with ancillary staff. Through Urgent Maters, we were also able to measure our success by benchmarking against other hospitals. This provided a cascading effect encouraging the entire organization to strive to reach new levels of success in all of our throughput initiatives.”

Maryann Singley
Vice President, Clinical Services, Westmoreland Hospital


Profile:
Location: Greensburg, PA
Number of emergency department visits annually: approximately 41,000
Number of beds: 301
Affiliations: Excela Health System
Ownership: non-government, not-for-profit
Teaching status: Yes

Westmoreland Hospital, located in central Westmoreland County, is a full service, acute care hospital and regional referral center with 301 licensed beds.

Clinical areas affected:

  • Emergency department
  • Inpatient units
  • Ancillary departments

Staff involved:

  • Nurses
  • ED Staff
  • IT/technical support
  • Ancillary departments

Timeline:
Implementing the improvement took approximately six to eight weeks of initial work before rollout. The Westmoreland team conducted two re-evaluations, tweaking the form used according to feedback received from staff.

Contact:
Maryann Singley
Vice President of Clinical Services
P: (724) 832-4479
msingley@excelahealth.org

Innovation implementation:
When patients were transferred from the ED to the inpatient units, the opportunity for a gap in the handoff due to poor communications existed, resulting in delays in care and poor patient throughput rates. Examining their handoff processes, the team at Westmoreland Hospital saw that improving the communication of information during this process could result in significant improvements in their ED boarding times and patient safety.

Their solution was to develop a communications system consisting of a standardized patient information form that is filled out by the ED nurse and faxed to the receiving department’s floor nurse as part of the hand off process. Through this system, the team recognized that all of the patient’s pertinent information could be shared before the handoff, increasing efficiencies and minimizing patient delays.

Westmoreland started the process by meeting with the ED and inpatient teams. The implementation team spelled out their goals to improve the process and asked departmental representatives to go back to their respective departments and tell their colleagues about their roles in making this a successful innovation. This inclusive process was seen as critical to the efforts to securing cultural change in the system, learning from a previous process improvement effort, which was deemed unsuccessful due to lack of collaboration.

To implement this project, Westmoreland had to be able to better communicate with floor staff during the admitting process. As such, they created a standardized inpatient report sheet that provided for the input of general patient information as well as other signs and symptoms essential for the nurses on the floor. To help reduce the likelihood that this information would be delayed or lost, the hospital turned to fax machines for instantaneous transmission of the sheets. Now, every unit has a fax machine that can receive the sheet once completed by the ED staff, thus closing the loop on this simple but effective innovation. Taking this strategy one step further the hospital is now piloting an online form that can be viewed by the inpatient units prior to the patient’s transfer.

The result of the new communications process and tool has been nothing short of amazing, with a 50% improvement on patient throughput seen since its implementation.

Advice and lessons learned:

  1. Be persistent and don’t fear failure. Implementation of a version of this program was attempted several years ago with limited success. Rather than become discouraged, the staff learned from their mistakes which led to a successful implementation this time.
  2. Welcome suggestions on the process—but be firm. Keeping the affected departments informed about this project at every step of the way is critical for success. Make sure everyone knows that you intend on completing your project, and continually seek insight as to how you can improve it.
  3. Don’t reinvent the wheel. Learn from others. Meeting with other hospitals was beneficial to learn about strategies other hospitals were implementing and the associated challenges that came with their projects.

Cost/benefit estimate:
This project represented a small investment with a big payoff. The upfront costs involved adding another fax machine to a unit and having two administrators manage the program, both of which represent somewhat of a fixed cost. The payoff from this minimal investment was a 50% improvement on patient throughput.

Tools:

  • Emergency Department Worksheet
  • Faxed Report Form for Emergency Department, Inpatient and Nurse Supervisors