Background: Hospital admission is a complex process and more often than not workflows are not aligned leading to delays in patient care and safety issues.
Purpose: Align and coordinate care between different disciplines from registration process to admission to the floor to improve patient care, efficiency and safety.
Description: Over 100 hours of observation were performed of processes from patient registration to admission to the floor. Through this observation, several opportunities were identified that would improve patient safety and, align workflows of different departments including ancillary departments. The goal of this project was to make the admission process more streamlined, efficient, and also safer. After working with a multi-disciplinary team the biggest barrier and delay was noted to be secondary to poor communication. Opportunities were identified in every department including hospital medicine workflow. Based on these observations, some processes were changed in the hospital medicine department. The admitting hospitalist and pharmacy technicians were provided a room in close proximity to the ED. Each admitter was assigned no more than 1 patient at a time to focus on efficiency. Once this admission was done, they were assigned another patient. At the busiest hours, they would carry a max of 3 patients at one time. This led to less pages, increased efficiency, decrease in handoffs and ultimately better patient care. ED physicians provided verbal hand off to the hospitalist admitting the patient in real time and there were less handoffs between hospitalists as the triage hospitalist was eliminated. Pharmacy was able to prioritize the patients based on admission sequence thus completing the med history on time. The closer communication led to quicker and more detailed sign out by ED nursing to the floor nursing and more efficient transport to the floor secondary to better communication with bed control and transport. Overall, the co-location of these teams members leads to better communication all around.
Conclusions: The median time from admission request by ED to the time that hospitalists finished admission decreased from 144 minutes to 94 minutes leading to a decrease by 50 minutes. This was an improvement of 35% in terms of time efficiency. This efficiency lead to patient safety as well since nursing care also improved due to timely order placement. Overall, this process was safer and more efficient leading to better patient care.
