Five innovations to improve patient flow through emergency departments

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Five innovations to improve patient flow through
emergency departments
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Introduction
This guide is for Health Services aiming to
improve their ED services. Flow through emergency
departments for admitted patients is largely
related to effective internal processes and
accessibility to ward beds. Flow through
emergency departments for ED discharged patients
is largely related to effective ED process
design. The five strategies are simple.
Implement the five strategies alone or in
combination to make substantial improvements to
patient flow and patient care. Use this guide as
the starting point to develop an ED improvement
plan. Click on the tabs to progress through the
five improvements. Additional resources to
support the innovations are available in the
Patient Flow Change Package. For further
information on the Patient Flow Collaborative,
please visit www.health.vic.gov.au/patientflow
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Service focus
One Service Focus
Two Streaming

• Engage with consumers
• Train staff in customer service
• Improve waiting room environments
• Consider important sub groups needs children
  and the elderly
• Increase communication about next steps
• Link the community through care coordination and
  HARP strategies
• Adding value to the patients experience is the
  primary focus

Three Flow
Four Staff capacity
Five Remove Duplication
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Streaming
One Service Focus
Two Streaming

• Define commonality in groups of patients and
  develop systems to meet these common needs.
  Commonality may be found in
• outcome care needs
• clinical problem resource needs.
• Reduces multiple queues and low value
  processes.
• Streaming may
• eliminate sequential queues and waits
• promote interdisciplinary teams and shared
  assessment and care
• bypass unnecessary steps (eg direct admission to
  assessment units from the community / GP)
• Streaming focuses on the specific needs of groups
  of patients and decreases the use of generic,
  less efficient systems.

Three Flow
Four Staff capacity
Five Remove Duplication
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Flow
One Service Focus
Two Streaming

• Create capacity for flow rather than using demand
  driven push strategies to force flow
• Stream patients according to common needs
• Plan capacity to meet the predictable nature of
  emergency inflow on a day by day and hour by hour
  level
• Manage variation in flow of elective patients
  around the predictable emergency demand
• Reduce variation in length of stay by
• improved discharge process
• increased day procedures
• Develop and focus on ambitious flow targets, not
  targets that define system failure

Three Flow
Four Staff capacity
Five Remove Duplication
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Staff capacity
One Service Focus
Two Streaming

• Increase flexibility in staff skills
• Develop and implement advanced nursing roles
• Integrate allied health, eg. advanced
  physiotherapy as primary care providers
• Foster multidisciplinary teams such as care
  coordinators
• Roster staff to meet demand patterns where
  possible
• Integrate sub-discipline skills and team members
• aged care physicians
• psychiatric nurses
• general physicians
• paediatric emergency physicians

Three Flow
Four Staff capacity
Five Remove Duplication
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Remove duplication
One Service Focus
Two Streaming

• Integrate information management to remove the
  need to duplicate documentation between and
  within care professions
• Eliminate unnecessarily repeated clinical
  investigation
• Ensure clarity of orders and clinical notes to
  eliminate misinterpretation and reworking
• Meet the patients needs with the right person at
  the right place and time to decrease duplication
• Aim for single assessments where clinically
  feasible

Three Flow
Four Staff capacity
Five Remove Duplication
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Acknowledgements
Jenny Bartlett Chief Clinical Advisor, Office of
the Chief Clinical Advisor Lee Martin Manager,
Clinical Innovation Agency Director, Patient Flow
Collaborative Marcus Kennedy Clinical Lead,
Patient Flow Collaborative Patient Flow
Collaborative Team Rochelle Condon, Improvement
Lead Ruth Smith, Improvement Lead Fiona Dickson,
Improvement Lead John Walker, Communications and
Logistics Lead Prue Beams, Data Analyst
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Contacts
Support to implement these system wide
initiatives is available via the Patient Flow
Collaborative team who can be contact
via Clinical Innovation Agency Email cia_at_dhs.vi
c.gov.au Phone [phone] Patient Flow
Collaborative Team Lee Martin 9616 7859
Manager, Clinical Innovation Patient Flow
Collaborative Director Rochelle Condon 9616
9026 Improvement Lead Ruth Smith 9616
9025 Improvement Lead Fiona Dickson 9616
9030 Improvement Lead Prue Beams 9616
7742 Data Consultant John Walker 9616
9037 Communications and Logistics Lead
The Patient Flow Collaborative