Solving the Dilemma of Wait Times in the Emergency Department by: Nicole Chan

Introduction/Background ● ED has become overcrowded and unable to meet the demands of its patients ● 2010 Affordable Care Act ● Institute of Medicine (IOM) confirms ED overcrowding is becoming a national epidemic

Introduction/Background Cont’d ● Current research in the nursing and medical community on ways to reduce wait times in the ED ● Key Findings ● Clinical Implications

Introduction/Background Cont’d ● PICOT: In ED patients, how does the implementation of a fast track or rapid treatment zone, compared to ED’s who have not implemented a fast track or rapid treatment zone, decrease wait times and improve quality of care for patients prior to discharge from the ED?

Key Findings ● A fast track is the most common intervention reviewed to effectively reduce wait times and length of stay in the ED ● Fast track: an addition to the main ED where low- acuity patients are evaluated by a mid-level care provider. ● Positively impacts nursing by improving ED flow

Clinical Implications ● Plan for change: o designate a room/number of beds to be the fast track area o arrange staff including a mid-level care provider and nurses o use current triage acuity system to designate low- moderate acuity patients to triage

Barriers/Facilitators to Change Barriers: ● Current triage system may not support optimization of flow in a fast track Facilitators: ● no additional renovations to ED required ● no additional staffing required ● no additional policy changes needed ● no additional training required ● no compromise in patient care

Ethical and Cultural Considerations ● Patient population served and perception of mid-level care providers compared to the MD ● Lack of resources including translators ● Ethical principles of Beneficence and Justice

Expected Outcomes and Measurement Expected Outcomes: ● reduced wait times and length of stay ● improved ED flow ● better nursing care Measurement of Outcomes: ● 3 months ● Electronic Medical Record (EMR) o wait times and lengths of stay

Conclusion ● Fast track is a promising solution for ED overflow ● Fast tracks improve wait times and lengths of stay ● Improved nursing care is an additional benefit ● Research is needed for potential nationwide implementation ● Cultural considerations must be addressed regarding scope of practice of mid-level care providers and patient education

References Aksel, G., Bildik, F., Demircan, A., Keles, A., Kilicaslan, I., Guler, S., &... Dogan, N. (2014). Effects of fast-track in a university emergency department through the national emergency department overcrowding study. Journal Of The Pakistan Medical Association, 64(7), Cheng, I., Lee, J., Mittmann, N., Tyberg, J., Ramagnano, S., Kiss, A., &... Zwarenstein, M. (2013). Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times. BMC Emergency Medicine, 13(17). doi: / X Considine, J., Lucas, E., Martin, R., Stergiou, H. E., Kropman, M., & Chiu, H. (2012). Rapid intervention and treatment zone: Redesigning nursing services to meet increasing emergency department demand. International Journal Of Nursing Practice,18(1), doi: /j X

References Doyle, S. L., Kingsnorth, J., Guzzetta, C. E., Jahnke, S. A., McKenna, J. C., & Brown, K. (2012). Outcomes of implementing rapid triage in the pediatric emergency department. Journal Of Emergency Nursing: JEN: Official Publication Of The Emergency Department Nurses Association, 38(1), doi: /j.jen Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., Williamson, K.M. (2010). Critical appraisal of the evidence: Part I. AJN, 110(7). 47 – 52. Gutierreez, S. (n.d.). Texas Man Dies After Waiting 16 Hours for Treatment in ER. Retrieved April 6, 2015, from Han, J. H., France, D. J., Levin, S. R., Jones, I. D., Storrow, A. B., & Aronsky, D. (2010). The effect of physician triage on emergency department length of stay. The Journal Of Emergency Medicine, 39(2), doi: /j.jemermed

References Marco, C. A., Moskop, J. C., Schears, R. M., Stankus, J. L., Bookman, K. J., Padela, A. I., &... Bryant, E. (2012). The ethics of health care reform: impact on emergency medicine. Academic Emergency Medicine: Official Journal Of The Society For Academic Emergency Medicine, 19(4), doi: /j x Paul, J., & Lin, L. (2012). Models for improving patient throughput and waiting at hospital emergency departments. Journal Of Emergency Medicine ( ), 43(6), doi: /j.jemermed Rankin, J. A., Then, K. L., & Atack, L. (2013). Research: can emergency nurses' triage skills be improved by online learning? Results of an experiment. Journal Of Emergency Nursing, doi: /j.jen Stauber, M. A. (2013). Advanced nursing interventions and length of stay in the emergency department. Journal of Emergency Nursing, 49(3), , doi: /j.jen /j.jen

References Theunissen, B., Lardenoye, S., Hannemann, P., Gerritsen, K., Brink, P., & Poeze, M. (2014). Fast Track by physician assistants shortens waiting and turnaround times of trauma patients in an emergency department. European Journal Of Trauma & Emergency Surgery, 40(1), doi: /s White, B. A., Brown, D. M., Sinclair, J., Chang, Y., Carignan, S., McIntyre, J., & Biddinger, P. D. (2012). Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department. The Journal Of Emergency Medicine, 42(3), doi: /j.jemermed