Berkeley Research Group, LLC, Emeryville, California (Dr Chmielewski); St. Charles Hospital, Catholic Healthcare Services of Long Island, Port Jefferson, New York (Ms Tomkin); Good Samaritan Hospital, Catholic Healthcare Services of Long Island, West Islip, New York (Ms Edelstein).
Adv Emerg Nurs J. 2021;43(1):79-85. doi: 10.1097/TME.0000000000000335.
The most common site for hospital sentinel events due to care delays, secondary to waiting and/or inefficient processes, occurs in the emergency department (ED). Decreasing patient length of stay in an ED is a key initiative for many hospitals in order to maximize both quality and efficiency. The purpose of this practice improvement project was to (1) standardize front-end processes across a 6-hospital health system, (2) move non-sorting-related clinical questions out of triage, and (3) improve door-to-triage and door-to-provider times. The project occurred within a 6-hospital East Coast health system. This was a continuous quality improvement initiative utilizing the Donabedian theoretical model, plus the DMAIC method, for process improvement. A system-wide performance work team was formed including ED leaders and staff; site-specific implementation teams were also formed. Rapid triage implementation was effective in producing statistically significant improvement in door-to-triage, door-to-provider, and ED length of stay for discharged patients at 3 of the 6 sites. Further performance improvement projects in this area are needed to better understand the generalizability of this process in other EDs. Furthermore, from a leadership perspective, additional investigation is needed into the cost savings as well as shared labor opportunities that may exist when policies and processes are standardized across a system's service line.
由于等待和/或效率低下的流程导致的医院哨点事件最常见的发生地点是急诊科（ED）。为了最大限度地提高质量和效率，许多医院都将缩短 ED 患者的住院时间作为一项重要举措。本实践改进项目的目的是：（1）在一个拥有 6 家医院的医疗系统中标准化前端流程，（2）将与分类无关的临床问题从分诊中剔除，（3）缩短从进入急诊室到分诊和从进入急诊室到医生的时间。该项目在东海岸的一个拥有 6 家医院的医疗系统内进行。这是一项持续的质量改进计划，利用了 Donabedian 理论模型，再加上 DMAIC 方法进行流程改进。成立了一个涵盖 ED 领导和员工的全系统绩效工作组；还成立了特定于站点的实施团队。快速分诊的实施在 6 个站点中的 3 个站点，在分诊、从进入急诊室到医生的时间和 ED 患者的住院时间方面产生了具有统计学意义的改善。需要在该领域开展进一步的绩效改进项目，以更好地了解这一流程在其他 ED 中的推广性。此外，从领导层的角度来看，当政策和流程在整个系统的服务线中标准化时，需要进一步研究可能存在的成本节约和共享劳动力机会。
