1. BOARDING SOLUTIONS INCREASE PROFITS BY ENDING ER GRIDLOCK © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS Emergency Medicine Summit 5/4/2011

2. BRIDGE ORDERS: DECREASE TIME TO DEPART FOR ADMITTED PATIENTS TAMERA BARNES, MD, FACEP © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS

3. How to start a Bridge Order initiative How do Bridge Orders affect ED Operations Monitoring for Continued Success (C) COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS OBJECTIVES

4. BUILD CONSENSUS © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS MEET WITH YOUR ADMISTRATOR TO GET THEIR SUPPORT MEET WITH HEAD OF HOSPITALIST GROUP MEET WITH ED PHYSICIANS IRON OUT SPECIFICS OF THE PROGRAM DEVELOP A HAND-OFF TOOL TO ENSURE INFORMATION EXCHANGE IS MAXIMAL FOR PATIENT SAFETY MEETING BETWEEN ED PHYSICIANS AND HOSPITALISTS MONITOR DATA; INTERMITTENT MEETINGS

5. HAND-OFF TOOL © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS PATIENT’S NAME/PCP DIAGNOSIS/CHIEF COMPLAINT VITAL SIGNS SIGNIFICANT POSTIVE AND NEGATIVE TESTS TESTS STILL PENDING ED COURSE TYPE OF BED (I.E. TELEMETRY, ICU, ETC.) INPATIENT VS. OBSERVATION

6. WHEN NOT TO WRITE BRIDGE ORDERS © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS IF PATIENT UNSTABLE IF CONTROVERSY WHETHER PATIENT MEETS INPATIENT CRITERIA

7. DASHBOARD DATA © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS BEFOREAFTER ED VISITS21842238 ARRIVAL TO TRIAGE 3.025.78 ARRIVAL TO GREET21.0827.19 LWBS %0.6%0.85% ADMITS24.8%23.7% DISPO TO DEPART (ADMITTED PTS) 172.869.3

8. WHAT DOES THAT MEAN FOR YOUR HOSPITAL? © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS 103.5 MIN SAVED 23.7% ADMIT RATE = 530 ADMITS THAT MONTH 530 X 103.5 MIN SAVED/ADMIT = 54,855 MINUTES SAVED OR 915 HRS AVG LOS FOR ALL ED PATIENTS 150-180 MINUTES CREATES CAPACITY FOR 304-365 MORE PATIENTS WITH SAME STAFF, NO ADDED BEDS $100/PT. = AVG COLLECTION FOR ED MD = $30,000/MONTH $350/PT = AVG COLLECTION FOR HOSPITAL = $122,500/MONTH OR $1.4 MILLION PER YEAR $4000 HOSPITAL REVENUE/ADMITTED PT X 78 MORE ADMITTED PATIENTS/MONTH = $312,000/ MONTH OR $3.7 MILLION PER YEAR ON ADMISSIONS FROM ED TOTAL INCREASED REVENUE = $5.1 MILLION

9. QUESTIONS? © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS