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Nonprofit Innovation Awards: Hospital’s emergency department flips process for healthier results


Winner: Management Operations

It’s a dilemma shared by hospital emergency rooms around the
country: how to serve more people in the same amount of space – without
compromising the quality of care or holding up its delivery.

At York County’s Memorial
Hospital, the solution
has meant overhauling the way patients flow through the emergency department.
The department handles more than 40,000 patients a year, up from 15,000 a
decade ago.

The biggest change, instituted in October, plants a doctor
in the waiting room to help sort patients and point them where they need to go.
The hospital also added new positions and revamped its registration procedures
so they don’t stand in the way of patient care.

“It’s a complete change in thought process for our
emergency-room staff,” said Kandy Duncan, emergency-services director at
Memorial, which is in Spring
Garden Township.

Patients with stab wounds, crushing chest pains or other
serious conditions still head directly to a bed in the emergency department, Duncan said. Other
patients are divided into three groups by a doctor in the waiting room, known
as a physician in triage, or PIT.

“We’ve actually flipped the ER on its back because,
traditionally, the last person you saw when you came in for treatment was the
doctor,” Duncan

Patients who need X-rays, IVs or other diagnostic procedures
start getting that work done in the waiting room. If privacy is needed, doctors
can use one of two small treatment rooms off to the side.

People with cuts, broken bones, earaches or other ailments
are sent through what is called the FastER, where they see a physician
assistant who can wrap up treatment. People with minor ailments, such as a
nagging cold, receive prescriptions.

To speed patient flow, Memorial created two new positions
solely for the ER. One is a vascular access technician, a lab tech able to draw
blood and start IVs. The second is a flow tech, a person who takes care of
administrative tasks for the physician, such as checking on test results.

Another key innovation is a process called short
registration, or short reg. A nurse takes down basic information – name, birth
date and chief complaint – and enters it into a computer system that others in
the ER can use to track the patient. The more extensive registration can wait
until down time during treatment, Duncan

This summer, the ER’s space will undergo renovation to
accommodate the changes in personnel and procedure.

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