Lean project makes Tuality Emergency Department more efficient

July 11, 2012

For immediate release
Contact:  Gerry Ewing / 503-681-1654

Tuality Healthcare’s newly remodeled 4-bed Rapid Care Unit, combined with a Pivot Nurse to direct patient flow upon arrival to the Emergency Department, will drastically reduce wait times, increase patient safety and satisfaction and create efficiencies for Emergency Department staff. The Pivot Nurse position is the result of a collaborative approach embracing the Institute for Healthcare Improvement’s performance improvement methods known as “Lean.” This was a staff- driven design facilitated by Team Health’s Quality Initiative and Intel’s Rapid Integrated Lean Process©.

The Emergency Department has a split flow of patients. A patient with minor injuries and illness will be directed to the Rapid Care Unit, while those with more serious health issues will go to the main Emergency Department. When the Pivot Nurse is on duty, patients not arriving by ambulance will be evaluated, or “triaged,” and registered simultaneously. The goal for the Emergency Department is 30 minutes door to doctor time, less than 1 percent of patients leaving without being seen and 150 minutes total length of stay.

The Rapid Care Unit and Pivot Nurse will alleviate crowding in the main Emergency Department, creating a more streamlined approach. The Rapid Care Unit is designed for “patients that we think won’t take a lot of resources - simple lacerations, simple fractures, sore throats, earaches, back pain - people that aren’t going to take multiple X-rays or multiple lab tests or medications,” said Val Collins, Clinical Nurse Manager for Tuality Healthcare’s Emergency Department.

Current statistics show the Emergency Department’s current door-to-doctor time at 28 minutes, left without being seen rate at 1.6 percent and total length of stay at 154 minutes.

When both the Rapid Care Unit and main Emergency Department are full, nurses will perform rapid triages for those currently in the waiting room to gather vital signs, and ask more detailed questions regarding the patient’s health concerns. “We will be taking care of those patients faster, they won’t have to sit in the waiting room until there is a bed available or staff available,” Collins said.

Additional benefits are:

• An initial assessment of the use of a Pivot Nurse to direct patient flow as they arrive in the ER showed the arrival to room time was reduced from 22.75 minutes to 6 minutes. An average of 45 patients are seen a day from 3-11 p.m. in Tuality’s Emergency Room – in one month, this translates to over 382 patient hours saved.

• Increased patient satisfaction. One patient said: “Sweet – this is so much faster than the last time I was here.”

• The Pivot Nurse allows the Charge Nurse and Rapid Care Nurse to remain at their respective posts in the Emergency Department, saving an anticipated annual cost of $8,000.

• A Pivot Nurse eliminates the potential need to move patients from the Rapid Care Unit to a room for post assessment, saving an anticipated annual cost of $4,500.

• Total savings from staffing the Pivot Nurse function from 3-11 p.m. are projected to be about $27,500 annually.

To view a video highlighting the new Rapid Care Unit, go to: