The newly designed flow model also involved the creation of small internal waiting rooms (see Figure 2) to keep patients moving forward, with a goal of never sending them back to the main waiting room.
Explore This IssueACEP Now: Vol 37 – No 01 – January 2018
Finally, a front flow facilitator monitored flow into the department and kept things moving in the front of the department, while a back flow facilitator monitored flow in the major care areas and into the hospital. These highly trained and experienced nurses performed no direct patient care but rather functioned like air traffic controllers, making sure that flow into and out of the department was smooth and efficient.
The results were astounding. First, the productivity of the minor care areas more than doubled. The variation was proportional to the ESI breakdown of arrivals that 24-hour cycle (see Table 1).
Then in terms of measured operational performance, the new model really rocked. The VCU emergency department is now posting median wait times to see the physician of fewer than 10 minutes and walkaway rates of less than 1 percent (see Table 2).
Most departments of such high volume, with teaching missions and tertiary care delivery, find it hard to achieve this kind of performance. By engaging the physicians and staff early and delegating pieces of this global improvement project to individuals, they moved the entire department forward. The VCU leadership team refused to accept mediocre metrics, and together it put its vision in action!