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LO23: Reducing time to disposition for treat & release patients in the emergency department
| Content Provider | Scilit |
|---|---|
| Author | Woolner, V. Ensafi, S. Leon, J. De George, L. Chartier, L. |
| Copyright Year | 2018 |
| Abstract | Introduction: Treat and Release (T&R) patients are seen and discharged home from the emergency department (ED), and asked to return within 12-72 hours for follow-up care (e.g., ultrasound, repeat blood work). Our two academic teaching hospitals see approximately 2,000 T&R patients per year. Handover of care for T&R patientsdone through charting only and therefore dependent on the charts adequacy and completenessis crucial to the safety and quality of care they receive. An 18-month retrospective chart audit at our sites identified quality gaps, including suboptimal documentation that ultimately impedes patient disposition. Our projects aim was to reduce the time-to-disposition (TTD; time spent by patients between provider initial assessment and discharge from the ED) by a third (from 70min) in 6-months time (March 2017), a target felt to be both meaningful and realistic by our stakeholder team. Methods: Our primary outcome measure was the TTD (in minutes). Our process measure was the quality of documentation, using a modified version of QNOTE, a validated tool used to assess the quality of health-care documentation. PDSA cycles included: 1) Involvement of stakeholders for the creation and refinement of an improved T&R handover tool to cue more specific documentation; 2) Education of health-care providers (HCPs) about T&R patients; 3) Replacement of the previous T&R handover tool with a newly designed and mandatory tool (i.e. a forcing function); 4) Refinement of the process for T&R patients and chart hold-over. Results: Run charts for both the median TTD and median modified QNOTE scores over time demonstrate a shift (i.e., run chart rule) associated with the second and third clustered PDSA cycles. After the first three clusters of PDSA cycles (i.e., before-and-after), mean TTD was reduced by 40% (70min to 42min, p=0.005). The quality of documentation (mean modified QNOTE scores) was also significantly improved (all results p<0.0001): patient assessment from 81% to 92%, plan of care from 58% to 85% and follow-up plan from 67% to 90%. Conclusion: We reduced the time-to-disposition for T&R patients by identifying gaps in the quality of documentation of their chart. Using iterative PDSA cycles, we improved their time-to-disposition through improved communication between health-care providers and a new T&R handover tool working as a forcing function. Other centers could use similar assessment methods and interventions to improve the care of T&R patients. |
| Related Links | https://www.cambridge.org/core/services/aop-cambridge-core/content/view/479AA9A54DBE4A970EB4BB688CBDFC30/S1481803518000854a.pdf/div-class-title-lo23-reducing-time-to-disposition-for-treat-and-release-patients-in-the-emergency-department-div.pdf |
| Ending Page | S14 |
| Page Count | 1 |
| Starting Page | S14 |
| DOI | 10.1017/cem.2018.85 |
| Journal | Canadian Journal of Emergency Medicine |
| Issue Number | S1 |
| Volume Number | 20 |
| Language | English |
| Publisher | Cambridge University Press (CUP) |
| Publisher Date | 2018-05-01 |
| Access Restriction | Open |
| Subject Keyword | Canadian Journal of Emergency Medicine Respiratory System Quality Improvement and Patient Safety Emergency Department |
| Content Type | Text |
| Resource Type | Synopsis |
