29
a patient is waiting for lab results, or waiting for a bed either in the ER or the
hospital, depending on severity. In addition, these breakdowns all have
significant communication components such as managing the waiting room,
collaboration between the ED and supporting departments, better discharge
instructions, and cooperation between the ED and the floors to facilitate more
expeditious movement of patients.
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Study findings were presented in the form of a summary cultural narrative
to both ED management and hospital senior administration (see Appendix).
Many of the observations described above were used by a newly formed
interdisciplinary organizational development team to create baseline measures
and implement a number of targeted interventions. Some of the changes that
occurred were a direct result of this study, and others reflected both our findings
and ongoing efforts on the part of the Director, the Physicians Group, and the
Nurse Educator. The changes were as follows:
•
Hiring of an additional (third) patient advocate
•
Hiring of greeters to direct patients upon arrival to the ED
•
More timely physician communication with patients once brought back to
treatment area
•
New approach to room stocking in the morning
•
Patient meal tickets made available during long delays
•
Improved triage through continuing education
•
Meetings with Pharmacy and Phlebotomy to clarify expectations and
improve support
One implication of this study is that the current “ER crisis” in America can
usefully be conceived of as a crisis of communication and process management.
The Directors of Emergency Departments across the nation are held accountable
Convention