Reducing Throughput Time in the Rapid Evaluation Unit: Meeting the State Benchmark

Abstract

Problem: An Emergency Department (ED) in the Mid-Atlantic region has encountered challenges meeting the state benchmark for “treat and release” patients. Their throughput time averages 341 minutes, which is 41 percent above the benchmark of 241 minutes. Initial review of throughput time in the Rapid Evaluation Unit (REU) indicated interdepartmental time lost in workflow and processes. An effort to decrease “dwell” time is an organizational priority. Purpose: The practice change implemented was optimized technology supporting visual cue management and an indicator of Computerized Tomography (CT) scan readiness for the ED Radiology Department. The ED Radiology technicians documented a “reason for delay” if patients with CT indicator were not ready for the exam. A column on the tracking board indicated to the REU if the patient was not ready and the reason or that ED Radiology was ready for the patient. REU reports were modified to collect the date/time stamps in the Electronic Health Record (EHR) to measure the time intervals from “CT order” to “CT completed” along with “patient not ready for exam” and the indicator. Methods: All patients (> 18) undergoing CT in the REU were included in the 15-week quality improvement project. Structure goals were to provide an indicator to the tracking board when a patient is ready for CT and implement a form to discretely document delays and measure the order to completed intervals in the EHR. The outcome goal was to reduce the radiology “dwell” time by 25 percent. Results: Data showed variable use of the “Patient not Ready” form and outcome goals were not met. Process goals indicated that 77 percent of CT delays were due to lack of intravenous access, point of care human chorionic gonadotropin (POC-HCG) and laboratory results. Turnaround times for CT remained around the historical baseline of 135 minutes. Conclusions: The structural and process goals of the project were achieved. Conversely, analysis of the data collected did not suggest a consistent decrease in “dwell” time in the radiology process as it related to the visual cue management, optimization in the tracking board and the discrete documentation of reason for delay.