Emergency Department

1
Emergency Department

• November 8, 2005

2
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

3
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

4
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.

5
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.

6
Daily Patient Volume

• Daily volumes vary little with slightly fewer
  patients seen on Thursdays

7
Hourly Patient Volume

• Most patients arrive between 0700 and 2300.
• Peak arrivals at 1000 and 1900.
• Fewest patients arrive between 0400 and 0600.

8
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

9
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.

10
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.

11
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.

12
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.

13
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.

14
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.

15

• People Caring for People