A statewide program in North Carolina promotes early initiation of evidence-based heart attack treatment through collaboration with trained paramedics and partnerships between and within hospitals, leading to earlier initiation of therapy and faster transfer of patients.
A hospital-based telephone triage system allows patients to describe their symptoms to a nurse, who uses an algorithm to assess acuity and determine the best setting for treatment, leading to reductions in emergency department patient volumes, wait times, average length of stay, and walkouts.
In instances of institutional overcrowding, a protocol allows patients admitted to the hospital but boarded in the emergency department to be transferred to beds located in inpatient unit hallways, leading to expedited patient placement in a room, lower length of stay, and higher patient and staff satisfaction.
During peak census hours, phlebotomists are assigned to work in the emergency department to quickly collect blood specimens and label them for priority processing and analysis by laboratory staff, leading to faster turnaround times, lower rates of blood culture contamination, more than $400,000 in annual cost savings, and higher levels of patient satisfaction.
Firefighters and emergency medical technicians use a computer-based system to connect 911 callers, particularly those who call frequently in nonemergency situations, to community-based health, social service, behavioral health, and other services, leading to meaningful reductions in nonemergency calls, particularly among frequent callers.
A comprehensive initiative to improve stroke care features protocols to facilitate faster evaluation and diagnosis, quick administration of tissue plasminogen activator when indicated, 24-hour access to a neurologist, enhanced discharge planning, improved documentation and data collection, continuous staff training, and community outreach, leading to more timely administration of appropriate diagnostic tests and treatment and to many more eligible patients receiving tissue plasminogen activator.
A separate emergency center for older patients includes physical features to reduce anxiety and discomfort, staff trained in geriatric care, and routine followup monitoring after discharge, leading to high levels of patient satisfaction, detection of polypharmacy, increased patient volume, and a low rate of return visits.
Concurrent and postdischarge nurse chart review, performance feedback, and other support lead to near-perfect adherence to recommended care processes for heart attack, heart failure, pneumonia, and surgery.
Emergency department–based physical therapists provide care to patients with minor musculoskeletal problems, leading to anecdotal reports of improved quality, efficiency, and patient/physician satisfaction.
A hospital used a multipronged strategy to reduce delays in patient admission and discharge, eliminating ambulance diversions and reducing waiting times for patients who require inpatient admission.