Jay will recall that our most dramatic remedy for patient flow
bottlenecks occurred at The Children's Hospital of Alabama when we
bypassed triage anytime doctors and rooms were available to see the
Rud Polhill, M.D.
Assoc Prof of Ped
Div of Ped Emerg Med
The Children's Hospital of Alabama
Univ of Al at Birmingham
jay pershad wrote:
> You are correct that this issue has come up before. I presume you are
> talking about physician shortage. Before you commit to a back up plan
> please be sure that indeed the bottlenecks during high volume census are
> due to physician shortage. It is my experience that there may be issues
> like nursing shortage, laboratory delays, RT shortage, admission process
> delays (room availability problems,floor resident team issues...
> ),discharge delays and last but not the least radiology delays, that tended
> to play a significant role.
> May I suggest to you, if you have not already, that during a representative
> high volume census period, you do a "time motion" study either
> retrospective or prospective in conjunction with administration. You may
> be surprised at what you find and when you have some objective time data,
> your case with administration will be stronger.
> I believe there should be benchmarks/goals that every department should
> meet. For eg, after a bed request has been made the patient should be up on
> the floor in 30 minutes; All stat lab/radiology turnaround in an hour;
> provider to evaluate every patient within 30 min of being in the room;
> providers should have discharge capabilities from the room without always
> having nursing paperwork added on after the discharge order is signed; fast
> tracking every admission with orders within 30 minutes with full HNP done
> on the floor......
> An average ED would admit 10-20 % of their patients. This means 1 out of
> every 5-10 patients could potentially hold up the room for hours if the
> admission process is delayed!! It all adds up. I am not sure by adding more
> providers the wait times are going to be automatically reduced.
> Would love to hear the details of the issues in your ED since I work in a
> free standing Children's Hospital myself.
> Jay Pershad, MD
> Le Bonheur Children's Medical Center
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