Goal: To develop and implement a standardized process with tracking and accountability for emergency department (ED) consult requests. Innovation: Centralize the consult request process so that all ED requests and responses from consults go through the ED unit clerk. The strategy started paper-based and they are in the process of implementing an electronic version. Result: Although implementation was not easy due to initial resistance by both the ED physicians as well as the consultants, the project team persisted; and before too long, all physicians were seeing a smoother, more efficient consult process emerge. By the end of the UM project, Stony Brook had seen impressive results. They were completing approximately 725 consults per month and had decreased the ED length of stay of consult patients by one hour. Because of the new process, consultants are now more willing to provide “curbside consults” and have been much more proactive in solving their own staffing issues, which were slowing consults down. Other benefits included:

  • Improved phone etiquette and overall professionalism exhibited by unit clerks
  • Improved relationships between consultants and ED clerks
  • Improved relationships between ED and surgery department
  • Increased staff involvement in the change process provided more positive outcomes

Institution: Stony Brook University Medical Center 101 Nicolls Road Stony Brook, NY 11794 P: (631) 444-4000 From the Experts:

This was a very difficult strategy to implement because it affected quite a few physicians. However, the Urgent Matters structure and deadlines helped keep our team on track, and provided a framework to tackle this high profile and difficult change. Because of its success, we are now planning to implement a variation of this strategy throughout the hospital.

Eileen Dowdy, R.N., T&R III Nursing Quality, Emergency Department

Profile: Location: Stony Brook, NY Number of emergency department visits annually: approximately 75,000 Number of beds: 540 Affiliations: Stony Brook University Ownership: government, non-federal Teaching status: Yes Stony Brook University Medical Center is a 502-bed (32 in the ED) not-for-profit, teaching hospital in Long Island, N.Y. Clinical areas affected:

  • Emergency department
  • Orthopedics
  • Surgery
  • Neurology

Staff involved:

  • ED staff (nurses, physicians and technicians)
  • Consult service, including residents and attendings

Timeline: Implementation of the standardized ED consult process took approximately four months for development and pre-work followed by another three months for full implementation. Contact: Eileen Dowdy, RN, T&R III Nursing Quality, Emergency Department P: (631) 444-6972 Eileen.dowdy@stonybrook.edu