ILH EDDoor to Doc

Two Phase Improvement

1. Combine Triage and Quick RegMarch 16, 2009

2. Implement ED KaTJuly 16, 2010

Gravier St.

3 triage rooms

5 re

gist

ratio

n ro

oms

Chart stack waiting for

doctor

Waiting room

Pre-triage form holding area

Gravier St.

Chart stack waiting for

doctor

3 triage rooms

Waiting room

5 re

gist

ratio

n ro

oms

for

disc

harg

e or

full

regi

stra

tion

2 sign in Kiosks

2 registation techs

moved

Gravier St.

Before After

Serial to parallel

SMS Oct. intervals compared

SMS 2008 SMS 2009 SMS 20100

30

60

90

120

1522

11

15 3

4

7679

58

Reg to PhysicianTriage to RegArrival to TriageE

D K

aT

117 112

73

min

utes

medians

significant

Tria

ge re

g co

mbi

ned

SMS Nov. intervals compared(shows sustained for 2 months)

SMS Nov. 2008 SMS Nov. 2009 SMS Nov. 20100

30

60

90

120

15 2011

15 35

6667

54

Reg to PhysicianTriage to regArrival to Triage

medians

min

utes

NEW DATA Not yet submitted.9690

70

significant

Tria

ge re

g co

mbi

ned

ED K

aT

SMS to ED KaT Oct. comparison(arrival > triage > reg > physician)

Arrival to Triage Triage to Reg. Reg to Physician0

15

30

45

60

75

6.00 6.00

58.00

14.43

6.68

61.20

SMS 2010EDKAT 2010

min

utes

SMS to ED KaT Oct. comparison(arrival > reg > triage > physician)

Arrival to Reg Reg to Triage Triage to Physician0

15

30

45

60

75

8.003.00

50.00

14.44

0.00

61.20

SMS 2010EDKAT 2010m

inut

es

medians1440/5054

New Phenomena

1. Serial changed to parallel process(Quick reg. with triage) 0 minutes? Really?

2. Bedside registration

Results• Combining registration and triage shortened some time

intervals, but had no significant effect on door to doctor time.

• Implementation of ED KaT significantly shortened door to doc. (by 26 to 39 minutes)– (Other improvements may have had an effect. RTA, UCC)

• ED KaT times are longer than SMS times.– (ED KaT is probably more close to real time.)

• Results have sustained over at least 2 months.