Improving Patient Experience in the ED

Improving Patient Experience for Emergent Admissions

With well over half of all patients hospitalized in Canada admitted through the emergency department (ED), the overall patient experience hinges on how patients perceive the care they receive in the ED. ^[i]

For those with hospital admissions greater than 90 percent from the ED, the patient satisfaction stakes are even higher. Recently, a hospital senior leader asked our team what more they could be doing for patient experience given their high percentage of emergent admissions and correspondingly low percentage of elective admissions, which tend to report an overall better patient experience.

Below are three strategies we recommend for driving a positive patient experience:

1. Fast track all direct admission patients or elective patients to protect their arrival experience.
The goal is for patients to be admitted and in their bed within 60 minutes of arrival. It is imperative that patients receive effective communication using AIDET^® so they understand the plan for their care and feel comfortable. Nurse leaders should round on all new admissions within the first 12-24 hours to welcome them to the unit, provide relevant information, and let patients know that they will round on them daily during their stay. Although this may only apply to a small percentage of your admitted patients, it helps streamline and hardwire an effective admission process and creates a positive first impression. Be sure to validate patient turnaround times daily to see how close you are to the 60-minute arrival-to-bed goal. This lets you know if the process is working and holds admitting and patient placement members staff accountable for results.

2. Expedite ED admissions based on acuity and length of stay.
This is an inherent goal of every ED, but when a large percentage of all hospital admissions come through the ED, the approach must be relentless. Here are a few best practices that can help get the job done:

Patient placement coordinators or related roles should round together with the ED manager and charge nurse every four hours to talk to patients to keep them informed and ensure the patient’s clinical status is appropriate for the unit selected for admission. This keeps everyone updated on the status of patients and informs decisions about prioritizing admissions.

Inpatient nurse managers should round on ED holding patients at least once a shift to introduce themselves to patients, assess clinical status, ensure admission orders are in progress, and show care and compassion to the patient. This is a big win for both ED holding patients and ED staff as it demonstrates partnership and ownership.

The CNO plays a big role in the quality of the experience for ED patients. The CNO should round with the ED Manager on all patients with hold times greater than four to six hours and then round again with those same patients within 24 hours of arrival on the inpatient unit. This sends a strong message to staff and patients that expediting care and admissions from the ED is a priority and helps the CNO assess how well the admission process is working and what specifically needs improvement. To drive accountability and transparency, the CNO will want to review admission process metrics daily at patient flow meetings. Lastly, the CNO provides coaching for leaders who are underperforming and leads sub-groups for areas that need process improvement.

3. Focus on your care transitions.
Effective and safe handovers from the ED to inpatient units are critical to patient safety, clinical outcomes, and the overall experience of our patients. There are some best practices for ED to inpatient care transitions you can implement and you should also consider the impact of handovers happening across the continuum of care.

For information on how Studer Group Canada helps organizations achieve powerful improvements in the emergency department through specialized coaching, contact Bonnie.Colchrane@studergroup.com.

^[1] Canadian Institute for Health Information, Understanding Emergency Department Wait Times: Access to Inpatient Beds and Patient Flow (Ottawa: CIHI, 2007).