Emergency Department Annual Census ~60,000 Daily Census ~ 160 - PowerPoint PPT Presentation

Emergency Department

� Annual Census ~60,000 � Daily Census ~ 160 (Range 130-220) � Admission Rate ~23% � Emergency Department is comprised of the Triage/Medical Screening area, and four treatment areas, or zones � 27 treatment rooms/bays and 8 treatment stations in designated hallway areas � 8 Clinical Decision Unit Beds � Full Staffing � 17 RN’s + Charge Nurse for ED � 2 RN in Clinical Decision Unit � 7 Ancillary Staff (MEA/Clerk)

� Up to 4 work stations � Two private offices � Two additional spaces as needed � 2 RN’s � Greeter—RN or ancillary staff � Recent Flow/PI Projects have included adding a provider at triage during peak hours to see appropriate patients from the lobby and discharge home � RN staffing can be flexed up during provider at triage times and also during peak volumes

� 8 treatment rooms and 4 gurneys in designated hallway areas � 4 resuscitation rooms � 4 exam rooms � Patient census fluctuates throughout the day along with acuity � Ambulance Diversion when Zone 1 census reaches 12 � Highest acuity patients � Trauma Activations initial evaluation � Medical Resuscitation � Violent or Agitated patients � 6 Assigned Nurses � Charge Nurse can flex RN assignments and provide additional Zone 1 support during periods of high acuity and/or census

Trauma Resuscitation Room

� Circulator Nurse � Makes patient assignments � Coordinates breaks and break coverage � Assigns RN’s for each trauma case � Works closely with Charge Nurse and Attendings to coordinate Zone 1 flow � Can take low acuity patient assignment � Acuity Nurse � Typically, does not takes a patient assignment � Performs bed side care, tasks, transports, and monitoring of patients � Primary Nurse � Takes patient assignments up to 4 patients

� 4 open treatment bays � Staffing � 1 Primary RN � 1 Float/Break RN (floats between Zone 2 & 3) � MEA (floats between Zone 2 & 3) � Medical complaints, minor injuries, admitted patients, and evaluated & stable trauma patients

� 5 open treatment bays and 1 private exam room � Staffing � 2 RN’s � 1 MEA (floats between Zone 2 & 3) � Medical complaints, minor injuries, admitted patients, and evaluated & stable trauma patients

� 9 exam rooms and 4 gurneys/chairs in designated hallway areas. � 2 negative pressure � Staffing � 3-4 RN’s � 1 MEA � 1 NP � Medical complaints, minor injuries, admitted patients, and pediatrics

� Located on 4C � 8 Beds � Staffing � 2 RN’s � 1 MEA � 1 NP � Defined inclusion/exclusion criteria � Observation patients and admitted patients

� During periods of: � increased acuity --or-- � increased census --or-- � less than optimal staffing ...part of the CN role is collaboration with ED NM/ND/AOD in order to re-deploy staffing resources and to best fit the requirements of the department

= Redeployed RN’s

= Redeployed RN’s

JCC Report Diversion 2012—2013—2014 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2012 15% 20% 19% 17% 19% 20% 17% 22% 22% 26% 29% 39% 2013 34% 38% 39% 37% 36% 36% 43% 36% 42% 37% 34% 34% 2014 49% 39% 36% 36% 35%