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Posted August 12, 2016

Improving Patient Experience for Emergent Admissions

By Stephanie Baker, RN, MBA, CEN

With as high as three quarters of all unscheduled hospital admissions coming through the emergency department (ED), the overall patient experience hinges on how patients perceive the care they receive in the ED. 1

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:

  • 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 staff members accountable for results.

  • 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.

    • Don’t forget about the importance of coaching frontline staff as well. For more on this topic read Two Tactics to Elevate Patient Care and Frontline Staff Coaching.

  • Focus on your care transitions. Effective and safe handovers from the ED to inpatient units are critical to patient safety and clinical outcomes. Of all the patient experience measures included on the HCAHPS survey, care transitions has the highest correlation to overall patient satisfaction. Yet based on national averages, most organizations are not getting it right. 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 more on this topic, I recommend viewing Care Transitions 101, an excellent complimentary webinar hosted by my Studer Group colleagues who are subject matter experts on the impact of care transitions.

1 American College of Emergency Physicians. http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act. (May 2015)

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