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Table 1. Urgent Matters Learning Network (UMLN) II Summary Table

Table 1. Urgent Matters Learning Network (UMLN) II Summary Table

 Good SamaritanHahnemannSt. FrancisStony BrookThomas JeffersonWestmoreland
DemographicsLong Island, NY

537 Beds; Teaching; 70% Caucasian

Philadelphia, PA

640 Beds; Teaching; 55%; African American

Indianapolis, IN

185 Beds; Non-teaching; 95% Caucasian

Long Island, NY

540 Beds; Teaching; 75% Caucasian

Philadelphia, PA

765 Beds; Teaching; 49% African American

Greensburg, PA

301 Beds; Non-teaching; 97% Caucasian

The ProblemNearly half of ED patients are triaged to ESI III. This group has the highest LWBS rate.From December 2008 through February 2009, the ED LWBS rate was 12.7%.It has been a struggle to get non-emergent patients from the door to an ED bed in a timely manner.Long waits for specialty consults, long waits to see a physician, and many patients with low-risk chest pain were admitted without a definite diagnosis.Fast track inefficiencies have long been a source of frustration for ED leaders, staff, and patients.Significant problems have existed in the process of moving patients from the ED to inpatient beds. Significant boarding occurs.
The StrategiesExpedited care for a subset of ESI III patientsFive-level triage, immediate bedding, fast track ImprovementStandardized registration and triage processProtocols for specialty consults, CT coronary angiogram servicesFast track improvementED/inpatient department communication tool
Facilitators to ImplementationStrong leadership, enthusiastic staff, UMLN II, robust IT system, use of 5-level ESI acuity system, groundwork laid through prior effortsLeadership support, UMLN II, acceptance by newer staff, consistent reinforcement by department leaders, financial supportLeadership team champion, UMLN II, robust data infrastructure, previous success with other Lean/Six Sigma projectsFlexible staff, UMLN II, willing to make changes in response to feedback, robust IT system, tying strategy to department's strategic planLean methodology, staff-led strategy, strategy aligned with broader hospital initiative, appropriate allocation of staff, construction project for new space, UMLN IIElectronic version of tool, effective communication, simple solutions, shared responsibility, UMLN II, nurse champions
Barriers to ImplementationLonger planning time and training time than anticipated, limited supplies and variations by time, need to hire additional staff, initial lack of physician adherenceNP recruitment difficulties, resistance from more tenured nurses, failures by previous leaders to sustain change, information technology infrastructureResistance from registration leadership and staff, difficulties with process change, educational deficits, lack of capital funds for equipmentPhysician resistance to paper forms for consultant requests, regulatory barriers, inconsistent data collection, lack of staff training, insufficient staffing resources, competing prioritiesInsufficient staffing resources, health information technology challenges, triage errorsResistance from inpatient floors, past failures
Resources Required for Implementation$320,000 (12 reclining hospital chairs, 1 GYN stretcher, construction project)$490,000 (construction costs, several new NP hires)$32,850 (two workstations on wheels, standardized triage training)No additional resources requiredNo additional resources required$200 (fax machine)
Staff Time Required 65 staff hours1,217 staff hours across three strategies857 staff hours256 staff hours857 staff hours239 staff hours
Pre-Implementation LOS—Raw294 (all patients)
426 minutes (ESI III subset)		482 minutes207 minutes297 minutes122 minutes (fast track patients)257 minutes
Post-Implementation LOS—Raw287 minutes (all patients)
353 minutes (ESI III subset)		371 minutes200 minutes303 minutes147 minutes (fast track patients)264 minutes
Post-Implementation LOS—Regression-adjusted295 minutes (all patients)
357 minutes (ESI III)		430 minutes198 minutes306 minutes138 minutes (fast track patients)263 minutes
Pre-Implementation LWBS—Raw2.3% (all patients)
12.5% (ESI III subset)		10.7%Not availableNot availableNot available0.6%
Post-Implementation LWBS—Raw2.10% (all patients)
4.9% (all patients)		8.5%Not availableNot availableNot available0.4%
Pre-Implementation LWBS—Regression-adjusted2.2% (all patients)
Regression-adjusted scores are not available for the ESI III subset		10.0%Not availableNot availableNot available0.4%

Notes:

  1. The ESI III subset includes those patients presenting with one of six chief complaints: abdominal pain, flank pain, headache, pregnancy complication, vaginal bleeding, and vomiting.
  2. Bolded figures indicate significant improvement in patient flow measures at the p<.05 level.
  3. CT = computed tomography; ED = emergency department; ESI = Emergency Severity Index; GYN = gynecology; IT = information technology; LWBS = left without being seen; NP = nurse practitioner.

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Current as of September 2011
Internet Citation: Table 1. Urgent Matters Learning Network (UMLN) II Summary Table. September 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/ptflow/table1.html