Efficient patient flow is a critical challenge facing today’s emergency departments (EDs). Excessive wait times, high walkout rates, and poor patient satisfaction plague many emergency departments (Kelen et al., 2021). Implementing proven best practices for patient throughput offers a solution. However, successful change requires obtaining staff support. Thoughtful communication and engagement strategies can earn stakeholder buy-in and facilitate the adoption of improved ED workflows.
Initial Announcement Meeting
An initial announcement meeting will be scheduled with emergency department leadership, including the medical director, nursing manager, charge nurses, and physician and nurse champions. Current problems facing the emergency department will be outlined, including data showing long wait times, high left-without-being-seen (LWBS) rates, and poor patient satisfaction scores. It will be emphasized how this impacts not just patients but also staff morale and hospital revenue. The three proposed best practices, which are pull-till-full, bedside triage, and nursing protocols, will then be introduced along with an explanation of how each will concretely improve patient throughput. Successful implementations of these practices at other hospitals will be highlighted. The implementation timeline will be reviewed, and leadership will be requested to assist with change management efforts like educating staff, serving as role models using the new practices, and resolving any operational barriers.
Gaining Buy-in from Nurses
As frontline staff who will utilize the new practices, nurses are essential to the project’s success. A special introductory meeting will be held with them to provide additional information and get their input. Current emergency department problems and the evidence supporting the proposed solutions will again be outlined. Expected concerns like higher initial patient loads and changing the triage location will be directly addressed. These changes will be reframed as opportunities to provide faster clinical care and reduce the frequent stress of overcrowded conditions. The timesaving benefits of protocol-driven care will be emphasized, highlighting how standardized approaches enable nurses to operate at the top of their licenses and avoid duplicative or unnecessary steps. Nurse champions will be recruited to help demonstrate enthusiasm for the changes, provide peer coaching, and share positive experiences.
Engaging Physicians
As influential members of the emergency department team, physician buy-in and support are critical to successfully implementing the workflow change (Kelen et al., 2021). One-on-one meetings will be conducted with key attending physicians to explain the need for change, provide details on the new practices, and highlight the benefits to both patients and providers. Their vocal support and willingness to champion the changes among their peers will be requested. To continue physician engagement, an ED physician advisory team could be created. This group can help shape the new protocols to ensure they allow for clinical autonomy and quality standards while improving flow.
Staff Training Rollout
Comprehensive training will build staff capabilities, confidence, and enthusiasm for the new best practices. Dynamic training sessions will first provide the rationale for change along with step-by-step instructions on the new workflows. Hands-on components will allow staff to practice the procedures through simulated patient scenarios in a risk-free environment. Breakout discussions can help identify potential obstacles and develop collaborative solutions as a team (Kelen et al., 2021). Throughout each session, ample time will be reserved for questions, feedback, and clarification. Training will conclude with a knowledge quiz or skills demonstration to confirm understanding and comfort with the new practices before they are deployed.
Sustaining Engagement and Addressing Concerns
Open communication with staff will be maintained through regular huddles, leadership walk rounds, and joint problem-solving sessions. After several months, a follow-up survey can help identify any lingering adoption barriers requiring more training or protocol modifications. Continued data tracking will reveal if initial gains are sustained or if additional change management is required to achieve the desired emergency department flow improvements. With careful planning, engagement, and transparency, excitement can be generated for evidence-based changes that will directly improve patient care and staff workflow (Doyle, 2022). Ongoing communication and support will facilitate the successful implementation of best practices that enhance emergency department operational performance.
In conclusion, efficient patient flow is critical to emergency department success. The proposed changes of pull-till-full, bedside triage, and nursing protocols are proven to reduce wait times, walkouts, and bottlenecks. However, no operational solution can succeed without staff acceptance and proficiency. A thoughtful rollout focused on education, input, and open dialogue will enable the emergency department leadership to earn support and overcome resistance. Adaptability to address issues as they arise will also smooth the transition. With time and persistence, the project can achieve its goal of implementing workflow best practices that improve care for both patients and providers across the emergency department.
References
Doyle, G. W. (2022). Improving perioperative efficiency and patient throughput (Doctoral dissertation, Dublin City University).
Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., … & Sokolove, P. E. (2021). Emergency department crowding: the canary in the health care system. NEJM Catalyst Innovations in Care Delivery, 2(5).
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