Haemorrhaging money – Can EDs stem the flow?
Our trust has recently hired a management consultant firm to help improve our EDs performance (we’ve done this a few times over the last few years). One of the issues we’ve been focusing on is how to avoid the non-admitted breaches in the ED. Put simply, breaches of the 4 hour target cost trusts money.
I think it’s intuitive to most Emergency Medicine clinicians that if you get the patient started on the right journey right at the get go things go smoothly. The initial assessment of patients is key to getting it right first time – as opposed to the DIRE (doing it right eventually) situation we often find ourselves in.
The studies we’ve been conducting on SortED have amassed a large amount of data about the time we could have saved if we got the initial investigation and treatments requested earlier or if we had referred to Speciality or Ambulatory Care pathways earlier. We looked at whether this might have avoided any of the non-admitted breaches and low and behold it did! See Gillie’s November blog ‘Haemorrhaging money – How to get a grip’ for more details.
More importantly, this has a huge impact on patients’ care, especially for time dependant conditions such as stroke, heart attack, sepsis and major haemorrhage. For those patients who are not critically unwell, getting their journey moving early leads to a much improved patient experience.
My thoughts on initial assessment are not just about getting a comprehensive initial assessment with investigation and treatments orders early, but are also about how we manage a situation where 10 patients book in within a short time frame.
Currently we have a single Rapid Assessment team fixed in one place. That team can easily get overwhelmed when we get a surge of patients. The computers are fixed and it’s standard practice to write on paper the symptoms and observations and then transcribe onto a fixed PC terminal.
What would happen if we could flex this system up in times of surge, for example use some float nurses or any clinician that was free, armed with a touch screen pad, and start doing some initial assessments? The beauty of SortED is that it’s perfectly designed for this type of queue busting and still gets standardised and accurate results (as demonstrated in our studies). We could even look at designing a simplified version so some patients could assess themselves.
Getting a timely, standardised RAT like assessment would, in my opinion, really improve our performance for the non-admitted breaches – and stop us haemorrhaging money in the ED.
Barbara Cleaver – Nov 2018