Skip to main content

Advertisement

Table 2 Plan for High Activity

From: Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department

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.  
  1. AMCC Acute Medical Communication Central, ED Emergency Department