Mid-Track (Text Version)
Slide Presentation from the AHRQ 2010 Annual Conference
On September 27, 2010, Jeffrey L. Margulies, made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (1.2 MB). Free PowerPoint® Viewer (Plugin Software Help).
AHRQ Annual Conference
September 27, 2010
Jeffrey Margulies, MD, FACEP
Why: Collateral damage
A cartoon showing the emergency room is shown.
What: Identifying the Initiative
- 2.4% LWBS (left without being seen)
- Drill Down reveals ESI 3 issue
A pie chart is shown of the data above.
Who: ESI 3 Conundrum
- Patients are too complex for typical fast track visit.
- Not ill enough to be brought back immediately at times of high census.
- Result: highest LWBS rate for this subgroup of patients.
- Significant potential for morbidity
Who: Identify your target!
|Chief Complaint||LWBS Rate|
When: Do the math
An image of a bar chart showing the Avg number of Mid-Track Patients arriving by hour of day is shown. The peak is at 1700 hours (5 pm).
Where: Enter the Mid-Track
- Create a solution to address the needs of the ESI 3 patients.
- Insufficient space in current ED.
- ASU located above ED and available after-hours.
- Challenge: find a process that works and uses ASU space.
How: Mid-Track Evolves
- Concept: frontload patient visit.
- Nurse categorizes patient as ESI 3:
- Refers to physician sitting in triage.
- Physician in triage, but not triaging:
- Only sees ESI 3 pts with 1 of 6 CC.
- Phlebotomy station set up near triage.
- After initial evaluation pts go up to ASU.
- Care coordinated with NP for entire shift.
An image of the Good Samaritan Hospital Medical Center Mid-Track Process Flow Chart is shown.
- Process design quite challenging.
- Start time critical to front loading:
- Bolus of patients when MT starts at 4p
- Pts 'triaged' to MT before 4pm
LWBS rates pre and post Mid-Track
|All Patients Pre Mid-Track||All patients post Mid-Track||ESI Level 3 pre Mid-Track||ESI level 3 post Mid-Track||6 Chief Complaints pre Mid-Track ESI Level 3||6 Chief Complaints post Mid-Track ESI level 3|
- Positive response from patients.
- Favored by staff.
- Reduced stress levels in the ED.
- NP role better defined than previously.
- Hospital renewed focus on throughput.
- Mitigated our natural tendency towards procrastination.
Future of Mid-Track
- Successful initiative to date.
- Expand hours and days of operation.
- Expand ESI 3 patient complaints.
- Included in new ED redesign.
An image of the evolution of the wheels is shown.
Thanks to the team!
- Charles Bové
- Carol Butler
- Curt Cicotte
- Susan Dries
- Mike Gewirtz
- Kathleen Lock
- Tom Nolan
- Rob Sharma
- Many others
On the right side of the slide is a photo of the team.