: INTERDISCIPLINARY PLAN PROPOSAL

The Emergency Room (ER) is continually a busy place and wait times are long. This affects not only patient satisfaction but also patient outcomes. Patients are incorrectly triaged or may be left waiting for long periods ...

The Emergency Room (ER) is continually a busy place and wait times are long. This affects not only patient satisfaction but also patient outcomes. Patients are incorrectly triaged or may be left waiting for long periods of time to be seen thus causing their conditions to worsen. The ER needs a strategic method in order for the system to flow smoothly while using a collaboration approach that encompasses all roles to decrease wait times and increase patient satisfaction as well as patient outcomes. “Emergency department (ED) crowding is a growing problem worldwide. Patients risk suffering prolonged pain, inconvenience and poor outcomes due to delays in emergency care. ED crowding can also lead to dissatisfaction among staff and a high rate of turnover as well as increased aggression and violence from frustrated patients” (Liu et al. 2018). Objective To establish an expedited and adequate emergency room workflow that is strategic while using an interdisciplinary collaboration approach. The proposed plan is called the Thrive Pathway, this is multidisciplinary driven triage system to expedite care by correctly identifying those who need immediate care vs those with non-urgent medical care. It will assist the ER team with identifying resources that are needed as well as areas that that increase waste thus reducing patient wait time and increasing favorable patient outcomes. Questions and Predictions 1. How does this triage system differ from the one currently being used? a. The triage system will be more doctor driven than nurse driven. The nurse will work side by side with the doctor at time of triage to collaborate and assess the acuity of each patient, instead of the nurse solely assessing the patient and completing the triage. 2. How does this new triage system benefit the patient and staff? a. Ideally the patient should be examined within 20 minutes or less from the time of their arrival to the ER. During the exam the doctor can dictate what resources are needed and which area of the ER the patient will be seen in. This system will focus on necessary resources needed while reducing waste that may increase a patient wait time in the hospital. Since resources are ordered at time of triage, staff can anticipate what the patient will need and what additional resources may be needed thus limiting waste. 3. What will change in the ER system to accommodate this process? a. Patients will be screened and roomed based on acuity determined by the doctor and the nurse, using the Emergency Severity Index (ESI). The ESI is a five-level triage algorithm that categorizes ER patients by evaluating both patient acuity and resource needs, with 1 being the most critical and 5 the least critical (Agency for Healthcare Research and Quality, 2020). Based on the ESI, the patients will go to either one of the three areas of the ER after going thru a marked pathway. The three areas are the evaluation rooms (ESI of 4 or greater), treatment rooms (ESI of 3-4 with non- complicated diagnosis) and main ER rooms (ESI of 1-3 with complicated diagnosis). If the patient is not critical (ESI of 5) they can be seen, treated, and discharged at time of triage per the doctors’ discrepancy. The pathway is a set of orders determined by the doctor at time of triage. The patient can have an electrocardiogram (ECG) performed, labs drawn, and x-rays while waiting for a room to become available. By using this approach, the patient will have results ready once the patient is seen by a doctor, thus shortening treatment time in the ER. 4. Will this change increase the budget for additional staff or resources? a. There will be a slight increase in the budget. This system will be categorized as the thrive team and the thrive pathway. The Thrive team will need a dedicated thrive charge nurse (besides the charge nurse) and triage doctor that will be responsible for managing the whole system flow each shift along with additional float nurses to expedite the process flow. The Thrive team will communicate with two way hand held radios to enhance communication between each other. A handheld instruction guide, called the Passport, must be created for both the patient and staff. This guide will assist both staff and patient what resources the patient will need and what area of the ER the patient will be examined. Rooms will need to be allocated and areas will be redefined to accommodate the Thrive pathway process. Additionally ancillary services will work together with the ER to expedite the process by converging resources in one centralized location as well as assist in transporting patients between these resources. Change Theories and Leadership Strategies One change theory that can lead to this interdisciplinary solution is the Lean Theory. “The Lean Systems Approach (Lean) is a people-based system, focusing on improving the process and supporting the people through standardized work to create process predictability, improved process flow, and ways to make defects and inefficiencies visible to empower staff to take action at all levels” (Wojciechowski, Pearsall, Murphy, & F