Emergency Department November 8, 2005

”Wall time” No data collected –Current systems do not allow for collection of meaningful metrics –In process of evaluating EDIS systems Perception –“Typical” wall time ~ 15 minutes –HC is rarely on delayed offload –HC receives patients from other areas due to delayed offload time and diversion

Patient Acuity No data collected –Current systems do not allow for collection of meaningful metrics –In process of evaluating EDIS systems Perception –Normal distribution of patient acuity –Shift towards the lesser urgent, if any –Admission rate = 18% –Fast Track rate = 20%

Annual Patient Volume Health Central has experienced a 12% increase in ED volume over the previous 3 years. Projected for an additional 4% growth this year.

Monthly Patient Volume Monthly volume ranges from 4,145 to 4,909 patients. Least patient volume is seen in June and the most in March. Little seasonal effect on volume.

Daily Patient Volume Daily volumes vary little with slightly fewer patients seen on Thursdays

Hourly Patient Volume Most patients arrive between 0700 and Peak arrivals at 1000 and Fewest patients arrive between 0400 and 0600.

Wait Time No data collected –Current systems do not allow for collection of meaningful metrics –In process of evaluating EDIS systems Contributing Factors –Backlog of inpatient admissions –Volume / Surge capacity –TAT –LWOT focus

Wait Time Process Improvements - current –Implemented 23 treatment protocols to standardize and expedite patient treatment. –Implemented ED Saturation plan. –Implemented the “HCPS plan”. –Added second Triage Nurse 12pm-12am.

Wait Time Process Improvements - planned –Bedside registration in Fast Track and whenever an ED Exam Room is available. –Off-site referrals for non-urgent patients. –Discharge Planner program.

Recommendations Allow hospitals to update EMSystem re: saturation levels, staffing critical etc. Implement scored diversion system. Replicate “HCPS” model county/city wide. Refuse non-urgent transports.

Recommendations This is not an EMS problem … or an ED problem … or a hospital problem. It is a health system problem that will require a system-wide solution.

Unreimbursed Care Approximately 28% of patients have no identified health insurance coverage. Due to contractuals, discounts, and bad debts approximately 76% of Emergency Department charges are not reimbursed. The Health Department and PCAN network are used for follow-up care.

Staffing Issues Contract staff are used to supplement current staffing. There is an inadequate supply of Registered Nurses in central Florida. Experienced nurses are particularly at a premium.

“People Caring for People”