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Tools: ED Throughput |  ED Treatment Path |  ED Clinical process |  Other ED |  Inpatient Flow |  Patient Satisfaction |  ALL

Tool / Best Practice (Alphabetical order)
Contributing Hospital / Description

30 Minute ER Promise (Categories: ED Throughput, ED Treatment Path, Patient Satisfaction)
Atlantic General Hospital - Staff wanted to improve the time it took for a patient to begin treatment to 30 minutes and created the '30 Minute ER Promise.' It guarantees that a patient will be placed in an exam room or begin to receive treatment, such as pain medication, x-ray, or lab tests, within 30 minutes of arrival at the hospital. (supporting document (PDF))

Admission Folder (Categories: ED Throughput)
Methodist Hospital - An admission folder has helped simplify the admission process and reduce unnecessary delays in admitting patients at Methodist Hospital.

Admissions and Discharge Center (Categories: Inpatient Flow)
Ingalls Memorial Hospital - Ingalls Memorial Hospital found that they were frequently diverting ambulances from their ED because they were unable to find inpatient beds for ED patients who required admission. Creating an Admission and Discharge Center helped facilitate these processes and improve patient throughput.

Bed/Patient Manager (Categories: Inpatient Flow)
Redlands Community Hospital - A patient/bed manageer at Redlands Community Hospital is dedicated to finding beds for all patients who require admission.

Bridging Orders (Categories: ED Throughput, Inpatient Flow)
St. Luke's Hospital - Hospital wanted to test whether an expedited admissions protocol would reduce ED turnaround times. An ED Nurse receives bridging orders for patients to be admitted and gives those orders to the admission nurse who finds a room for the patient, bypassing an admitting physician. The protocol decreased ED turnaround time by 20 percent.

Cardiac Alert Protocol (Categories: ED Clinical Process)
Gundersen Lutheran Medical Center - Gundersen Lutheran Medical Center works with EMS to quickly identify heart attack patients so that care is not delayed once the patient arrives in the ED.

Care Management Department Improvement (Categories: ED Throughput, Inpatient Flow)
Albert Einstein Medical Center - The hospital's leadership proposed several changes to the Care Management Department, which supported these changes as they would ultimately make their work more efficient.

Care Management Unit (Categories: ED Throughput, ED Treatment Path, Patient Satisfaction)
Grady Health System - A Care Management Unit at Grady Health System treats patients with specific common diagnoses in the ED.

Code Heart Process (Categories: ED Clinical Process)
Memorial Regional Hospital - A new procedure has helped Memorial Regional Hospital meet national standards for care in heart attack patients.

Code Purple (Categories: ED Throughput, Other ED, Inpatient Flow)
North Shore Medical Center - North Shore Community Hospital actively engages staff throughout the facility to help avoid diversion when the ED becomes over-crowded.

Collaborative to Improve Patient Flow (Categories: ED Throughput, Inpatient Flow, Patient Satisfaction)
Carondelet St. Mary's Hospital - A multi-disciplinary team at Carondelet St. Mary's Hospital set out to improve patient flow not just in the ED, but throughout the hospital.

Countywide Diversion Policy (Categories: Other ED)
King County EMS - King County EMS eliminated diversion at each of the county's hospitals. (supporting document (PDF))

Discharge Resource Room (Categories: ED Throughput)
Regional Medical Center, Memphis - The MED created a Discharge Resource Room (DRR) to address the problem of patients remaining in the ED after being discharged. (supporting document (PDF))

Discharge Trigger (Categories: Inpatient Flow)
University of Michigan Medical Center - University of Michigan Medical Center looked for improvements to decrease bed turnover time to allow more patients to be admitted to the hospital rather than boarding in the ED.

ECG Transmission (Categories: ED Clinical Process)
Duke University Hospital - Researchers at Duke University Hospital found that they could reduce time to treatment for heart attack patients by having EMTs wirelessly send ECG directly to cardiologists from the ambulance.

ED Demand Forecasting (Categories: Other ED)
Miami Valley Hospital - A common misconception is that ED visits are random and unpredictable, and therefore one cannot plan for such visits. However, ED leadership at Miami Valley Hospital recognized that not only is it possible to observe trends in ED visits, it is a necessary component to effectively running an ED.

ED Flow Manager (Categories: ED Throughput)
Moses H. Cone Memorial Hospital - Flow managers remotely monitor patient flow at each of the three hospitals in the Mose Cone Health System, identifying bottlenecks and looking for ways to fix these bottlenecks.

ED Information System (Categories: ED Throughput)
MetroHealth Hospital - A new ED information system helped MetroHealth Hospital better manage patient flow and decrease patient throughput times. (supporting document (PDF))

ED Registration Kiosks (Categories: ED Throughput)
Parkland Memorial Hospital - Parkland Memorial Hospital installed three registration kiosks, called MediKiosks, in the ED's triage area. When patients arrive at the ED, they spend several minutes entering the necessary registration information on a computer screen. (supporting document (PDF))

ED Satellite Laboratory Kiosk (Categories: ED Treatment Path)
Massachusetts General Hospital - A dedicated satellite lab within the ED has helped Massachusetts General Hospital decrease patient length of stay in the ED by reducing unnecessary waiting for lab results.

Elective Surgery Postponement Tool (Categories: Inpatient Flow)
Latter Day Saints Hospital - Latter Day Saints Hospital began delaying or canceling elective surgeries at times when bed capacity was strained. (supporting document (PDF))

EM Xpress (Categories: Other ED, Patient Satisfaction)
Valley Hospital Medical Center - An ED "Pit Crew" helps EMS offload patients.

Enhanced Triage Area (Categories: ED Throughput, ED Treatment Path, Patient Satisfaction)
Northwest Community Hospital - Northwest Community Hospital put in place an Advanced Triage Care Area, in which lower-acuity patients would be assessed, treated, and discharged having to wait for an ED bed.

Expanded Emergency Department (Categories: Other ED, Patient Satisfaction)
Kaiser - Sacramento/Roseville-Eureka - Kaiser Foundation Hospital-Eureka needed to expand ED capacity to accomodate the growing patient population. In addition to increasing the physical size, the ED was completely redesigned in an innovative way.

Expanded Observation Unit (Categories: ED Throughput)
University of Rochester Medical Center - University of Rochester Medical Center expanded its observation unit by more than four times in order to enable more patients to be admitted to the observation unit rather than taking up valuable ED beds.

Flow Technicians (Categories: Other ED)
Memorial Hospital of York - Memorial Hospital of York created two ED flow technician positions to handle such tasks as discharge instructions, finding charts and results for physicians, and checking to see that all patients have received the treatments that were ordered for them. (supporting document (PDF))

Frontline Physician (Categories: ED Treatment Path)
Methodist Willowbrook Hospital - Looking for a new strategy to help improve patient throughput, ED management at Methodist Willowbrook Hospital decided to redesign the triage process. (supporting document (PDF))

Growing Organizational Capacity (Categories: Inpatient Flow)
Lehigh Valley Hospital - Lehigh Valley Hospital focused on bed management issues to help reduce diversion.

Hospital-Wide Flow Capacity (Categories: ED Throughput, Inpatient Flow)
Bellin Hospital - Bellin Hospital took a hospital-wide approach to improving patient flow throughout the facility. In doing so, they saw a dramatic increase in the bed turnover rate.

Improvement Teams (Categories: ED Throughput)
Shady Grove Adventist Hospital - Three multidiciplinary teams at Shady Grove Adventist Hospital meet to look for solutions to patient flow problems throughout the hospital, not just in the ED.

Lean Manufacturing (Categories: ED Throughput, Patient Satisfaction)
Doctors Hospital - A "lean manufacturing" process helped Doctors Hospital improve patient throughput by eliminating unnecessary steps in the patient care process.

Maintaining Efficient Throughput (Categories: ED Throughput)
Wilson Memorial Hospital - Wilson Memorial Hospital actively took steps to maintain its fast throughput times and low left without being seen rates.

Mobile Clinical Decision Unit (Categories: ED Throughput)
John Muir Medical Center - In response to patient flow problems resulting from increasing boarding in the ED, John Muir Medical Center opened a Clinical Decision Unit (CDU).

Moving Patients in 30 Minutes (Categories: ED Throughput, Inpatient Flow)
Mount Sinai Hospital - Staff wanted to improve the time it took for a patient to begin treatment to 30 minutes and created the '30 Minute ER Promise.' It guarantees that a patient will be placed in an exam room or begin to receive treatment, such as pain medication, x-ray, or lab tests, within 30 minutes of arrival at the hospital.

New Ways of Working Program (Categories: ED Throughput)
Doctors Community Hospital - The American Hospital Association and Doctors Community Hospital teamed up under a program called "New Ways of Working" to improve its ED throughput.

No-Wait Emergency Department (Categories: ED Throughput)
Adventist GlenOaks Hospital - After several years of improvements, Adventist GlenOaks Hospital was able to completely eliminate waiting in its ED.

No Waiting Room (Categories: ED Throughput, Patient Satisfaction)
Ball Memorial Hospital - Ball Memorial Hospital re-built its ED with no waiting room.

Nursing Process Council (Categories: Inpatient Flow)
Cape Canaveral Hospital - Cape Canaveral Hopsital created a group to look at the patient-flow problems throughout the hospital and identify potential solutions to these problems. The group, called the Nursing Process Council (NPC) was made up of representatives from nursing, radiology, respiratory therapy, registration, and environmental services, with other departments participating as needed with specific problems.

Online Wait Times (Categories: ED Throughput, Other ED)
Scottsdale Healthcare - Scottsdale Healthcare posts waiting times online to let patients know how long they can expect to wait after arriving at the ED.

Patient Flow Coordinator (Categories: ED Throughput, Inpatient Flow, Patient Satisfaction)
Albert Einstein Medical Center - Long delays in the ED prompted Albert Eistein Medical Center to create a Patient Flow Coordinator.

Patient Flow Excellence & Accountability Team (Categories: ED Throughput, Other ED, Inpatient Flow)
Mary Washington Hospital - A Patient Flow Excellence & Accountability Team helped Mary Washington Hospital make process changes in order to meet requirements to maintain its status as an accredited institution.

Phone Consults (Categories: ED Throughput)
Johns Hopkins Bayview Medical Center - Admitted ED patients at Johns Hopkins Bayview Medical Center often waited hours to be transferred out of the ED and into an inpatient unit. This was addressed with a new procedure called the Phone Consult.

Point-of-Care Testing (Categories: ED Treatment Path)
Mercy Medical Center - Mercy Medical Center in Canton, Ohio implemented point-of-care testing to simplify the lab testing process because the tests can be performed in the ED.

Public Education and Remote Monitoring (Categories: ED Throughput, Other ED)
Lenoir Memorial Hospital - Lenoir Memorial Hospital began an aggressive advertising campaign to encourage individuals to visit their primary care physician for minor illnesses and injuries rather than the ED.

Quick Fix Team (Categories: ED Throughput)
John Muir Medical Center - The Quick Fix Committee meets monthly to identify needs and problems, brainstorm solutions, and implement and monitor the resulting changes in the ED.

Rapid Evaluation Unit (Categories: ED Throughput, Other ED)
Potomac Hospital - An enhanced triage with a rapid medical evaluation allows patients at Potomac Hospital to begin receiving care sooner than with a traditional triage system, which has helped reduce the hospital's LWBS rate.

Rapid Medical Examination (Categories: ED Treatment Path)
California Emergency Physicians - Under a RME system, patients are identified who are likely to be discharged quickly. These patients are sent to a separate room for an examination and minor testing, rather than waiting in the waiting room. Once testing is complete, patients are either discharged or returned to the waiting room.

Redefining ED Management (Categories: Other ED)
Northwestern Memorial Hospital - Northwestern Memorial Hospital redesigned its ED management in an effort to increase efficiencies and decrease patient wait times.

Scheduled Discharges (Categories: Inpatient Flow)
Kaiser - Sacramento/Roseville-Morse - Kaiser Foundation Hospital-Morse began scheduling discharges for early in the day in order to free-up inpatient beds for ED and surgery patients who required admission.

Six Initiatives (Categories: ED Throughput, Other ED)
Lutheran Medical Center - Lutheran Medical Center implemented six initiatives relating to patient flow and experience in the ED.

Standard Care Protocols (Categories: ED Treatment Path)
San Antonio Community Hospital - San Antonio Community Hospital wanted to establish standard protocols to begin treatment for specific conditions during long waits in the ED.

Surgery Smoothing (Categories: ED Throughput)
Boston Medical Center - To address the problem of moving inpatient admissions for quickly, Boston Medical Center worked on smoothing the surgery schedule. Elective surgeries were scheduled more evenly throughout the week, with surgeons only booking the operating room when a surgery was scheduled, rather than for large, fixed blocks of time each week.

Triage Treat and Release (Categories: ED Throughput, ED Treatment Path)
Lutheran Medical Center - Lutheran Medical Center created a Triage Treat and Release unit to care for lower-acuity patients with 25 protocol diagnoses in a designated area. This helped decrease congestion in the main ED area.

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