Sharonda Brown, BSN, RN: Improving Emergency Department Processes

In the first of a 3-part interview with MD Magazine, Sharonda Brown, BSN, RN, a senior emergency department consultant with American Academic Health System, at Hahnemann University Hospital, spoke about the process changes the hospital has made to improve the workflow of the emergency department.

Brown addressed how the administration surveyed staff and patients to look for opportunities to improve these processes in the front end, middle, and back end. She also spoke about the department's decision to remove non-value added steps from the triage process to prevent tediousness, as well as the addition of a Rapid Assessment Zone to shift the providers to the front end of the process and get patients in front of someone as quickly as possible.

Watch the next installment, Part 2 of the interview, here.

MD Magazine: The workflow of the emergency department here has improved very quickly—in just 2 months. How did that happen?

Sharonda Brown, BSN, RN, a senior emergency department consultant with American Academic Health System:

The first thing we did was we completed an assessment speaking with the teams, the directors, the nurses, as well as the physicians—and we did some patient surveys as well—to figure out what their strengths, weaknesses, opportunities, and threats were. We definitely prioritized them based on the threats.

The number of patients left without being seen was identified as an opportunity to jump on immediately, and that is a direct reflection of your front-end process. We have metrics in the emergency department that we break down into 3 phases: the front-end, the middle phase, and the back-end phase. We started with the front-end so that we can capture those patients in the lobby.

We changed the traditional process of triaging patients. The old-school process of obtaining a medical history, medications—what happens is throughout the United States is emergency departments have made that triage portion a tedious process and a long process before getting patients to the physicians. Our primary responsibility, our primary goal, is to get the patient in front of the doctor as soon as possible. The way that we do that is we remove non-value-added steps and the patient's processes or in the clinical processes.

Removing those non-value-added steps is decreasing the questions that we asked. Only those pertinent to make a decision on whether you need to be seen by a physician or not are being asked. Can you be seen by a mid-level provider? That mid-level provider is important to our vertical processes, and what I mean by vertical, is that every patient that comes to the hospital does not need a bed. What they want to do, though, is see the physician.

Can they see the physician in a chair, in upright status? In that case, we divert those patients to what we call our Rapid Assessment Zone. In that area, we shift our providers—and that was one of the major things that we did. One of the major changes was to shift our providers to the front end of our process. The patient seeing that provider in less than 10 minutes is our goal.

That provider would do a medical screening exam and enter orders. Once they enter those orders, those orders are carried out by a tech, on-site, immediately. Then once we get our labs off to the respective places, then we can make a decision. By the time the physician comes to the bedside then—and only after he's completed his assessment—will we make a decision on whether this patient needs to be admitted or discharged. Again, our goal is to decrease our emergency department overall length of stay.

Transcript edited for clarity.