Improving Emergency Department (ED) Throughput by Registering Patients by Acuity
Intervention Title: Improving Emergency Department (ED) Throughput by Registering Patients by Acuity – The Regional Medical Center (the Med); Memphis, Tenn.
Goal: Improve the ED intake process.
Innovation: Staff created a registration system in which patients are first triaged and then assigned a color code based on acuity.
Result: Registering patients by their acuity decreased the average ED visit time by three hours, and the percentage of patients who left without being seen dropped by six percentage points. In addition, the time between arrival and bed placement for admitted ED patients decreased.
Institution:The Regional Medical Center at Memphis 877 Jefferson Avenue Memphis, TN 38103 P: (901) 545-7100
From the Experts: “Fixing throughput times has to be a team effort—from the medical staff to the clerical staff. By color-coding our patients, it allowed all parts of the hospital to speak the same language and easily communicate with one another. Now our registration staff, nurses, bed control team and doctors can easily prioritize patients and move them through the ED quicker and more effectively.”
Rhonda Nelson, M.P.A.Vice President of Patient Care Services
Profile: The Med is a 355-bed, acute-care teaching hospitallocated in Memphis, Tenn.
Clinical areas affected:
- Emergency department
- Bed control
Timeline: After one week of rapid cycle testing, the color-coding identification system was fully up and running in one month.
Contact: Rhonda Nelson, M.P.A.Vice President of Patient Care ServicesP: (901) email@example.com
Innovation implementation: Many busy emergency departments register their patients in the order that they are triaged. While this system is often deeply entrenched in the hospitals' overall registration processes, it can contribute to overcrowding and be a limiting factor for throughput. Working to address throughput issues in the busy and frequently overcrowded ED at the Regional Medical Center at Memphis, a team implemented a registration system in which patients are first triaged and then assigned a color code based on acuity. Three colors were selected: RED = emergent, YELLOW = urgent and BLUE = non-urgent. Once the patient is assigned a color, they are sent, as appropriate, to registration where there is a dedicated registration clerk for each color code. In addition to streamlining the registration process, the change facilitated communication between all levels of staff, ultimately leading to decreased wait times.
Advice and lessons learned:
- Invite all levels of staff to the table.
- Gather data in advance
- Communicate to staff at the same time
Cost/benefit estimate: The new registration system decreased average visit time through the Med's ED from nine to six hours. Initially, 13 percent of those who registered at the ED left without being seen. That number dropped to seven percent once the color-coding system was put in place. In addition, the time between arrival and bed placement for admitted ED patients decreased from one hour to 30 minutes. For those ED patients who were discharged, the time dropped from one hour and 26 minutes to one hour and 10 minutes. For Fast Track patients, the time dropped from 11 hours to four hours and 41 minutes.