Emergency Department Teamwork Prompts Changes, Slashes Diversion Time

Emergency Department nurses participate in a disaster drill in June. Nurses have played an important role in the effort to dramatically reduce ED diversion time. (Photo: Ashley Heher)

Emergency Department nurses participate in a disaster drill in June. Nurses have played an important role in the effort to dramatically reduce ED diversion time. (Photo: Ashley Heher)

University of Chicago Medicine’s Adult Emergency Department is dramatically reducing ambulance diversion thanks to a cultural shift that’s taken place following three years of teamwork.

The ED racked up about 2,200 diversion hours in 2011, or about 184 hours a month. That amounts to asking ambulances to take patients elsewhere about quarter of the time because the ED faced capacity constraints. It was also the highest figure of any hospital in Illinois, according to state data.

But in 2014, the overall number of diversion hours has fallen to about 200 through the department’s “Drive to Zero” effort. In April and May, the hospital spent no time on diversion as nurses helped manage patient throughput.

What changed?

The transformation involved analyzing bottlenecks. Staff held more than 20 kaizens to inspire a new operating model. Lean methods helped the staff make changes, such as making sure every ED room had supplies in the same locations for consistency and speed. Meanwhile, nurses implemented a fast-track system to care for lower-acuity patients and reviewed labs while expediting patient care. Patients were triaged in available ED beds during slow periods and the Center for Care and Discovery provided more capacity to admit patients.

And through it all, the department’s entire staff was aware of the overall census and what steps they each could take to limit overcrowding.

“Our nurses play a vital role in patient throughput to provide the best overall care to our patients and our community,” said Edward Gutierrez, RN, BS, CEN, TNS, patient care manager in the ED. “The overall effort has created team work among staff and other departments and, more importantly, has created an environment where staff feel like they can make a difference.”

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