What is the problem? | Rating and Actions | |||
---|---|---|---|---|
Level 0 | Level 1 | Level 2 | Level 3 | |
Patients not being seen by a doctor within 1 h | < 6 | 6–11 | 11–20 | > 20 |
Patients with a length of stay > 3 h | < 6 | 6–11 | 11–20 | > 20 |
Total number of patients in ED | < 30 | 30–35 | 35–55 | > 55 |
Identify cause | Monitor situation | Fill out Template for High Activity. Identify reason for delay in medical review and take action. | Revise the template and map again. | Revise the template. |
A. Physician | Inform the senior resident when the number of medical patients ≥7. Inform the senior resident when the number of surgical/orthopedic patients ≥6. | Evaluate access to physicians, time spent, facilitate medical review. Inform the doctors on-call. Consider alerting the physician in triage in collaboration with doctors on call. | Evaluate access to physicians, time spent, facilitate for medical assistance. Inform the doctors on-call. Consider preparing your physician in triage in collaboration with doctors on call. | Ask for telephone meeting through AMCC. Report on: 1.Number of patients. 2.Causes 3. Actions already implemented |
B. Patient flow 1. Allocation to units. | Check the patient flow procedure. Inform the patient flow coordinator about the level of activity. | Inform the patient flow coordinator about the level of activity. Assist doctors on-call for reviewing patients code green in the triage area, and if necessary prior to triage. Further diagnosis and treatment takes place in the ward. | ||
2. Length of stay > 3 h. | Inform and discuss with responsible radiographer/biochemist about level of activity and coordination of actions. | Inform and discuss with responsible radiographer/biochemist about level of activity and coordination of actions. Evaluate if patients are transferred directly to the units before examinations and blood samples. | ||
3. Lack of infection room/ telemetry services in the units. | Discuss with the patient flow coordinator. Coordinate with the doctor on-call about reprioritizing. | Discuss with the patient flow coordinator. Discuss with the doctor on-call. Contact the service centre for infections for quick de-contamination of rooms. | ||
C. Location | Use waiting space 1–5 to release treatment beds. Use the ED critical care area; re-triage to treat, transfer or discharge patients. | Move patients to the corridor to release treatment beds. Use “The accident and the emergency surgical outpatient clinic” in cooperation with staff. | ||
D. Nurse | ||||
1. Long time as “ready for the doctor”. | Consider reallocating nurses to triage for physician assistance. | Consider reallocating nurse to triage for quicker patient flow. In collaboration with doctors on-call, consider reallocating patients from the observation unit to “The accident and the emergency surgical outpatient clinic”. | ||
2. Long time as “ready for transfer to unit”. | Reallocate nurses from other areas of the ED. | Reallocate nurses to the ED in cooperation with the Observation unit and “The accident and the emergency surgical outpatient clinic”. | ||
3. Too few nurses | Authority to call nurses into work up to a total of 9 nurses in the ED. | Authority to call nurses into work up to a total of 9 nurses in the ED. |