Mid-Track (Text Version)
On September 27, 2010, Jeffrey L. Margulies, made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (1.2 MB).
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.