Mid-Track (Text Version)

Slide Presentation from the AHRQ 2010 Annual Conference

On September 27, 2010, Jeffrey L. Margulies, made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (1.2 MB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

Mid-Track

Mid-Track

AHRQ Annual Conference
September 27, 2010
Jeffrey Margulies, MD, FACEP

Slide 2

Why: Collateral damage

Why: Collateral damage

A cartoon showing the emergency room is shown.

Slide 3

What: Identifying the Initiative

What: Identifying the Initiative

  • 2.4% LWBS (left without being seen)
  • Drill Down reveals ESI 3 issue

A pie chart is shown of the data above.

Slide 4

Who: ESI 3 Conundrum

Who: ESI 3 Conundrum

  • Patients are too complex for typical fast track visit.
  • Not ill enough to be brought back immediately at times of high census.
  • Result: highest LWBS rate for this subgroup of patients.
  • Significant potential for morbidity

Slide 5

 Who: Identify your target!

Who: Identify your target!

Chief ComplaintLWBS Rate
Abdominal pain4.6%
Flank pain3.5%
Headache5.5%
Pregnancy complication5.3%
Vaginal Bleeding6.1%
Vomiting2.5%

Slide 6

 When: Do the math I make 

When: Do the math

An image of a bar chart showing the Avg number of Mid-Track Patients arriving by hour of day is shown. The peak is at 1700 hours (5 pm).

Slide 7

 Where: Enter the Mid-Track

Where: Enter the Mid-Track

  • Create a solution to address the needs of the ESI 3 patients.
  • Insufficient space in current ED.
  • ASU located above ED and available after-hours.
  • Challenge: find a process that works and uses ASU space.

Slide 8

 How: Mid-Track Evolves

How: Mid-Track Evolves

  • Concept: frontload patient visit.
  • Nurse categorizes patient as ESI 3:
    • Refers to physician sitting in triage.
  • Physician in triage, but not triaging:
    • Only sees ESI 3 pts with 1 of 6 CC.
    • Phlebotomy station set up near triage.
    • After initial evaluation pts go up to ASU.
    • Care coordinated with NP for entire shift.

Slide 9

Good Samaritan Hospital Medical Center Mid-Track Process Flow Chart and... 

An image of the Good Samaritan Hospital Medical Center Mid-Track Process Flow Chart is shown.

Slide 10

 Lessons Learned/Challenges

Lessons Learned/Challenges

  • Process design quite challenging.
  • Start time critical to front loading:
    • Bolus of patients when MT starts at 4p
    • Pts 'triaged' to MT before 4pm
  • Cost
  • Staffing

Slide 11

 LWBS rates pre and post Mid-Track

LWBS rates pre and post Mid-Track

 All Patients Pre Mid-TrackAll patients post Mid-TrackESI Level 3 pre Mid-TrackESI level 3 post Mid-Track6 Chief Complaints pre Mid-Track ESI Level 36 Chief Complaints post Mid-Track ESI level 3
LWBS%2.56%1.93%4.90%3.08%6.96%3.90%

Slide 12

 Collateral benefits

Collateral benefits

  • Positive response from patients.
  • Favored by staff.
  • Reduced stress levels in the ED.
  • NP role better defined than previously.
  • Hospital renewed focus on throughput.
  • Mitigated our natural tendency towards procrastination.

Slide 13

 Future of Mid-Track

Future of Mid-Track

  • Successful initiative to date.
  • Expand hours and days of operation.
  • Expand ESI 3 patient complaints.
  • Included in new ED redesign.

Slide 14

Modern Healthcare  

Modern Healthcare

An image of the evolution of the wheels is shown.

Slide 15

 Thanks to the team!

Thanks to the team!

  • Charles Bové
  • Carol Butler
  • Curt Cicotte
  • Susan Dries
  • Mike Gewirtz
  • Kathleen Lock
  • Tom Nolan
  • Rob Sharma
  • Many others

On the right side of the slide is a photo of the team.

Current as of December 2010
Internet Citation: Mid-Track (Text Version): Slide Presentation from the AHRQ 2010 Annual Conference. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/margulies/index.html