NW FED Transfer Policy

Team:
The order we follow when dispositioning an admit is causing problems for quality metrics at the main. Below are how many were done correctly in the last month. I was unaware of the importance of this order and with the turn-over we have had I’m sure many are unaware as well. Please review and follow the flow below; I have attached the full policy for your review as well. Please note it states we need to do an MOT for intrahospital to NW and this is not correct; we will revise it.

• TSQ – 72.7% (16 correct out of 22)

• GST – 0% (0 correct out of 27)

Correct order to transfer for Cerner is important !

Click HERE to view the full NW FED Transfer Policy

P.5 FED to NW ED

Page 8: FED to NWT Bed

Positive Review

Great job team!  Whether they are good or bad, these reviews on Google get forwarded to me by the UHS FED VP.    I ordered frames to put the QR code cards in every room; please encourage feedback from patients while they wait for results.  Also, there is ample supply and I can reorder as needed for you to give them out at discharge.   Thank you ! Andrea

Google Review from 2/4/2022

The staff , nurses and doctors are the very best ! They all did an amazing job . Very professional and nice to me . They go above and beyond to diagnose, treat and care for people and I was impressed 😎

Joint Commission

The Joint Commission is due to come and audit NWTHS at any time and when they come they won’t want to know what I know, they will want to know what you know. Please learn these details and be ready to speak on them. Charge nurses: huddle these / review these with staff.

1. The auditor should arrive at the main campus first; they would at some point in the survey be brought over to the FED(s) at a scheduled time. HOWEVER, if they mistakenly arrive at the FEDs first follow these steps:

   1. Ask for their ID
      

   2. Do NOT bring them behind the doors of the FED, they should go to the main hospital so have them take a seat in the waiting room and..
      

   3. Tell the FED director and they will come talk with the auditor; if after hours or the director is unavailable - call the operator at the main hospital (ext 1000), tell them a JC auditor is at the site and you need instructions, they will call the quality manager, AOC, or house sup to give you instructions.
      

2. CT – will check to see if cabinet doors are locked that have contrast and the cleaning log for the Trophon.
   

3. They will randomly pick employee files to audit to make sure orientation, certification, competencies, and other requirements are in them. Please get your information to Tiffany Powers asap in order to keep your file up to date.
   

4. Fire – we have monthly (both shifts) fire drills, the safety officer, security officer AND fire officer is Kyle Hawley. KNOW WHERE the nearest fire extinguisher is regardless of where you are standing in the building, the Fire pulls/alerts are always by the doors so a person could always alert of a fire while exiting, know PASS, know RACE (should be on badge), call 911 for fire (not 8999…that’s for main).
   

5. No corrugated cardboard is allowed as storage in the building, please remove any and all that you see. This is a know source of roach and other small bug infestation / breeding.
   

6. There should not be any storage of any kind within 18” of the ceiling anywhere in the FEDs, this poses a fire sprinkler block
   

7. All curtains should be dated with an expiration date – they are good for 6 months or should be replaced when an infectious patient is in the room.
   

8. NO fake nail, gel, or any overlay except for ordinary polish and they shall be cut short, ¼”
   

9. There should only be patient food items, unopened, in date in the patient refrigerator and freezer; remove all staff items. Should the staff fridge be full, you may place items in the EMS fridge until we are stocking that regularly.
   

10. There should be a wheelchair by triage as chest pain and stroke complaints are not supposed to walk back to the rooms but be wheeled.
    

11. Code strokes are called overhead and go straight to CT and should be met there by all services represented at the FEDs; Dr. Hearts are called overhead and all resources should be in the room to facilitate landing them. Perform a FAST at triage to determine initial status and need for code stroke (go find out what this is if you don’t know)
    

12. We should now have a nurse at triage at all times when there are 3 RNs on duty
    

13. Regardless of nurse or tech at triage, if there is a line formed or more than one person at triage at a time what would you do ? call another staff member up front to ascertain chief complaints and assist with triage
    

14. Patients often want to discuss insurance and money at triage… how do you handle this ???? Once the patient has arrived, you can no longer discuss these issues until they have received an MSE from the physician. HOWEVER…WHAT CAN YOU SAY ???? “YOU ARE WELCOME TO HAVE A SEAT AND CALL YOUR INSURANCE FOR AN EXPLANATION OF EMERGENCY ROOM BENEFITS”
    

Not everyone will want to do that so be prepared with some other phrases like “we do not want to delay the process of providing you care with your condition at this Emergency Department”, or “Regulations don’t allow for us to delay care for emergencies by talking about payment and insurance until after you have seen the physician so we can start on your plan of care asap”.

If they call ahead, these items can be discussed on the phone; this part of EMTALA only applies to anyone on the grounds (on our facility property in any way…car, ambulance, etc).

1. Discharge instructions are very important. If you are unaware that you can add education to discharge instructions in Cerner, find out about this process. An auditor might follow you into a room and watch you give discharge instructions. IF THERE IS A SEDATION…. The patient must go home with education / information about the procedure AND sedation care information
   

2. SI / HI patient. There is a binder at each site with the policy and forms for this…know every bit of it ! This is a JC hot topic and more importantly, there are an increasing number of patients needing this help and we want to keep them safe. Every patient entering the ED gets a Suicidal Risk Assessment: The question is in the advanced triage (yellow plus) under “General / Screenings”-à “Suicidal Risk Assessment”. If you the patient indicates “yes” to this question, Cerner will bring up the “C-SSRS” which is the Columbia Suicide Severity Rating Scale. If the patient is on papers or deemed high risk by this scale, they must have a constant sitter without exception. Call the house sup, FED management, use lab,rad,techs…any means necessary to have a constant sitter. Documentation is key ! Should the patient who is a risk to themselves or others attempt to leave, we do not physically detain them but attempt to de-escalate, ask them to stay, call 911 and then our security, know which way they headed etc. and CHART CHART CHART all of this.
   

I’ll continue this thread as I think of other information you should know. Thanks for all you do !
Andrea

Schedule sign-up and Holidays

You will now find the schedule sign up which begins this Sunday for CNs then rotates around the rest of the FED staff on the main Nursing Newsletter page under Polices | Procedures | Processes.   Last time was a bit of mayhem, sorry, we will be following the process and will be careful to reject any sign ups that are placed prior to an employee’s correct day!   PLEASE DO NOT SIGN UP BEFORE MIDNIGHT ON YOUR ASSIGNED DAY !   For new staff:  you are assigned a “1” or a “2” based on the number on the far left which is in the same line as your name.    At the top of the spreadsheet you can see that “2” signs up on 2/7 and the “1” signs up on 2/8.  It will be in the reverse order next month.  Please ask for assistance in this process from other staff members or send me or Melissa a message.  

Click Here to View

Updates 1/26/2022

Not that it’s over, but our numbers have backed off a bit so we need to work on a few metrics that were difficult during the storm. Thank you all for staying in the boat! It has been mentally and physically exhausting; I hope that the nice staffing levels and bit lower census will give you all the break that you need and deserve.

1)    Staff Meetings:   starting Feb 8 we will have staff meetings the 2nd Tuesday of every month at 0645 and 1845.  We will try this in the TSQ west lobby by closing it down before we start.   50% attendance will be the expectation.

2)    Chart audits will begin again at the end of January – PLEASE INCLUDE A PAIN ASSESSMENT IN EVERY DISCHARGE VS SET.  As we continue to fill positions to staff with 2 techs per shift, this would be a great job for them to do on all discharge patients. 

3)    When there is a chart made in error like two for the same person, make sure to not discharge them as an LWOT or Left before MSE complete and if registration has to assist make sure they know it is not an LWOT but a REGE.   This is skewing our LWOT numbers.

1) Did you sign up for the FED party ???? https://nwthsfed.com/bowling-bash    Thurs, Feb 17, 7p-10p:     7p-9p bowling and a 1 hour game card that can be used during bowling or after 

2)    Melissa and I sent out an EKG email, read it in full, the highlights:  always enter patient identifiers before “muse and print” or transmitting, Dr needs to put time they saw it on EKG, we will soon be starting to scan our EKGs, AMAs, and other important forms…more to come. 

3)    AMA – there should be a form on every AMA chart, even if they do not stay to sign.  Important elements:  state that you gave risks/benefits or that you tried but they wouldn’t stay, that you attempted to get the Dr to talk to them but they wouldn’t stay, IF THE PATIENT DOESN’T SIGN THE AMA HAVE TWO NURSES OR THE NURSE AND A PROVIDER SIGN 

This is specimen / lab scanning: All labs should be collected at the bedside before the samples leave the room; the patient wristband shall be scanned and then the lab label scanned as well. Please be diligent in this practice. I know there have been issues with label printers, scanners, and computers. If these are not functioning properly at this point, enter a repair ticket and let me know as this process is an expectation we need to return to for patient safety. Below is last year’s data for GS and TSQ, you can see when our volume exploded that we had an obvious drop off in specimen scanning.

GS 2021 scanning

TSQ 2021 scanning

1)  Medication scanning:  Below are our rates from 2021. Below that is an explanation of what to do when there are two stickers, not sure this is an issue for us.  Place a midas or send us an email about meds that you can’t get to scan.

1)    This is last month…just to give you an idea of where we were last month and where we need to move towards.   Remember, I was here and know the issues, many of which we had no control over !  

 AVG discharge LOS should be < 90 min

LWBS (left without being seen by a provider, AKA LWOT left without treatment)  <0.25%

AMA rate <1%  (woohoo, we did that) 

My main concern is with the LWBS / LWOTS – I have asked the charge nurses to let me know details about each one of these.  Also, please help by putting in a note about the reason.  Make every effort to inform physicians when you feel a patient is a risk for leaving and make them as comfortable as possible.

1) Attached is information on EMTALA and EDs that corporate sent out, it’s a good read.

2) NEW STAFF !    Welcome travelers Stephanie, Tiffany Gravador-Flores, Diana arrives 1/27 and new NW to the FEDs Jayla, Rebekah, Michaela (starts 1/31), Brooke, Rick, Drew, Kasondra 

New Lab Tubes

We are switching labs collection tubes - the benefits are decreased hemolyses and decreased rejection rates, as well as smaller sample sizes.

We are switching labs collection tubes - the benefits are decreased hemolyses and decreased rejection rates, as well as smaller sample sizes.

CoVID19 Tests Back In Stock

NW received in 900 sars antigen tests 1/21/22 so we can resume to use these on ED patients (no, don’t worry not general public outpatient!).    Reminder – we will continue to do preop and OB outpatient covid testing per their order.   I believe some have come to the desk saying they need “covid testing” and we have told them we don’t do it anymore… if they don’t tell us they are OB or preop we won’t know so you might clarify their intentions or ask if they have an order.  They don’t have an understanding of all the types of testing like we do and what they should ask for.

Thanks!

Andrea

Blood Product Shortage

Due to severe national blood product shortage, UHS is changing how to order blood products in Cerner. Click Here to View Handout

New Education Tab!

Team,

There is a new “Education Resources” tab on the Nursing Newsletter! Check it out!

Here you will find the upcoming educational events, training videos (i.e. how to SMS patients), and more.

Let us know if there is something you think would be beneficial to add.

Update

Greetings!

1. REMINDER – remember to call the transfer center when an ambulance arrives to take a patient to the main ED. This is how they get placed on the Bed Board officially. We have been remiss to do this several times lately.

1. NEXT WEEK - JOINT COMMISSION MOCK SURVEY - an agency has been hired to come do a mock survey and inform us of what areas need attention before JC decides to show up. This will be next week 1/17-1/21/22. I will send out another email in the next day or two with tips…they will want to talk with YOU, not me, so be sure and read it closely !

1. CPAP – Philips V60 – please familiarize yourself with this device and find where the extra circuits are located. We will get respiratory to do more in-services; until then, I placed a pocket guide on each machine AND respiratory has a cell phone day and night where they can facetime and assist you (Day – 806-674-9911, Night – 570-2037). These numbers are on the Philips at the top as well.

1. It is an expectation that all will follow NW policy and wear masks at all times – we had 12 call-ins last week and already have 3 as of Monday. This may not stop the issue or spread of illness and call-ins but we have to ensure that a lack of following policy is not a factor in this contagion. Thank you to all who are picking up extra shifts or working a few hours here and there, it is the only way we are surviving.

 ***WE HAVE NUMEROUS SHIFTS AVAILABLE THIS WEEK AND THE ESP IS STILL IN EFFECT, CALL ME OR MELISSA IF YOU CAN DO ANY HOURS! THANKS*** 

1. This week is sign up week for schedule period 2/13/22 – 3/12/22 ! Also, we have many new people so I wanted to repost the “Soft Holidays” file – please turn this in ASAP, thanks 

1. I have several attendance notices to give out, I wanted to make sure everyone was aware that you can get an absence removed or forgiven. See email for the attached the form you will need to use.

Thank you for all you do!

Andrea

Update

Greetings!

REMINDER – remember to call the transfer center when an ambulance arrives to take a patient to the main ED.  This is how they get placed on the Bed Board officially.  We have been remiss to do this several times lately.

NEXT WEEK -  JOINT COMMISSION MOCK SURVEY -  an agency has been hired to come do a mock survey and inform us of what areas need attention before JC decides to show up.  This will be next week 1/17-1/21/22.    I will send out another email in the next day or two with tips…they will want to talk with YOU not me so be sure and read it closely !

CPAP – Philips V60 – please familiarize yourself with this device and find where the extra circuits are located.  We will get respiratory to do more in-services; until then, I placed a pocket guide on each machine AND respiratory has a cell phone day and night where they can facetime and assist you (Day – 806-674-9911, Night – 570-2037).   These numbers are on the Philips at the top as well.

It is an expectation that all will follow NW policy and wear masks at all times – we had 12 call-ins last week and already have 3 as of Monday.  This may not stop the issue or spread of illness and call-ins but we have to ensure that a lack of following policy is not a factor in this contagion.   Thank you to all who are picking up extra shifts or working a few hours here and there, it is the only way we are surviving.

***WE HAVE NUMEROUS SHIFTS AVAILABLE THIS WEEK AND THE ESP IS STILL IN EFFECT, CALL ME OR MELISSA IF YOU CAN DO ANY HOURS! THANKS***

This week is sign up week for schedule period 2/13/22 – 3/12/22 !    Also, we have many new people so I wanted to repost the “Soft Holidays” file – please turn this in ASAP, thanks

I have several attendance notices to give out, I wanted to make sure everyone was aware that you can get an absence removed or forgiven.   I attached the form you will need to use.

Thank you for all you do!

Andrea

CoVID19 Antibody Infusions

The Amarillo regional infusion center is open; however, they are now using the m. antibody sotrovimab since there is poor efficacy with the Regeneron on the Omicron variant.   I attached the form we are to use, throw all the others away.    This medicine is in short supply for the infusion center and they will have to be stringent on following their guidelines.   We will not be making the decisions of who gets the med or doesn’t but must remain diligent to do AND DOCUMENT the referrals or the offer of a referral.

We do not offer it at NW yet as it has been requested / ordered but not arrived; we would give it rarely as we have been doing Regeneron.   If it becomes available the pharmacy director told me she would let me know and update all the instructions/information. 

Thank you! Andrea

RSI Kits

If you only need an RSI and have time the kits can be pulled out of the fridge in order to not open med trays. Otherwise they are now on the crash carts! This will be very helpful to our processes. I appreciate pharmacy taking care of this so quickly!

Happy New Year!

Greetings, record numbers again this week, as difficult as it is please take turns sitting down for a few minutes, eat lunch, go look at the sky…something to help decompress.  Tiffany Pugh had a great suggestion that we have a code phrase at those melt-down moments when we need to take 5 or leave a patient room.  I was thinking “I’m going to check the helium tanks”…of course we don’t have any and helium makes things lighter

1)      There are otoscope bulbs at GS and they may look like either style shown below.   These are easy to replace, you just pull out the old one and push the new one in.  We will order more bulbs for both sites; hopefully this will keep these in use.   I have ordered more otoscope heads that have never arrived, I’ll continue to follow up on these.

2)      We are now giving out instructions for patients over 18 to be able to look up results on the patient portal.  Hopefully this will assist the patients and be a satisfier as well as cut down on our massive influx of calls.  We are working on this being available for <18yo as well.  Please make efforts to give patients.   They will need their MRN so either place a sticker on this sheet or point it out on their discharge paperwork.

3)      EKG stamp – there are two metrics for EKGs, door to EKG and EKG to viewed by Dr.    We are going to trial a red stamp on the EKG to help us obtain the time they viewed it.  We have one at TSQ and more are on the way.

4)    Staffing:

*** We are adding another tech 24/7 at each site – they are already posted, if you know anyone who might be interested have them apply and feel free to give them my cell ***

Makaela Springer is going from FT to prn

Marcos Garcia was already hired prn and he took Makaela’s position

Jamie Randall got a lab tech position in Tulia so she doesn’t have to drive anymore

Sharlene is coming to Jamie’s TSQ day position

Kasondra Morgan took Sharlene’s day tech position at GS (she used to be lab phlebot at main)

Cherri’s last day is 1/12

Heather’s last day is 1/13

Ashley Biskup WILL BE BACK MONDAY!

Stephanie Barrientez is a night traveler starting 1/17

I got approval for 3  more night travelers and will get them here asap

5)      ***I will confirm Monday – I heard there isn’t a Regeneron clinic anymore ??? ***   If it is open or opens back up the following is the process

City clinic  - monoclonal antibody process:   I know we have drilled in to not fax info to Dr’s offices or to numbers a patient requests etc and that remains true, this is the only exception at this time.

a.       Outpatient – if an outpatient patient tests positive and requests to go to the city clinic for antibodies, you can fax the covid result WITH a patient facesheet to the antibody clinic.  If the facesheet is not included, the clinic won’t have the right identifiers and patient phone number

b.      ED patient – the physician or nurse can fill out the inclusion criteria request form with Dr signature and fax it along with the positive result to the city clinic if the patient indicates they want the antibody infusion

6)      Melissa is rounding with information about calling a Dr Heart at triage, the required elements or goals, and where we struggle.  Please help us initiate this process.  Same for calling Code Strokes and going straight to CT

  Reminder – the physicians are supposed to start the indicator that they have been in a room which tells registration they can go in, please look for this to see if it is happening.  We shouldn’t discharge a patient if this indicator is not removed as it indicates they haven’t been registered.   It was in the last update for review and should start Monday.

SHOUT OUT – Thank you Macy !  She finished her nurse shift then jumped in the ambulance and transported a child to UMC that would have waited quite some time.  You’re the bomb!

HAPPY NEW YEAR !   I’M BELIEVING THAT 2022 WILL BE A GOOD ONE !

Thanks for all you do

Andrea

Employee Illness Return to Work

Good morning! In full effort to ensure all staff are working and not being held up by OH over the holiday weekends, please utilize the below guidance for return to work for illness.

• Employees calling in with symptoms need to remain off. They must be symptom free without the use of any fever reducing meds for 48 hours to RTW. Attached is a symptom monitoring log we have provided to all staff call ins. They are being told to document on the last 2 pages and return the form to show they have been symptom free. Please have them call OH so we can track them until they RTW.

• Anyone with an exposure (cohabitant/community/work that is fully vaccinated and NOT having symptoms. Can work but must document for 14 days from the date of exposure and turn the log to OH. If at any time they become symptomatic they will need to remain home. Again have them call to report to OH.

• Non vaccinated staff exposure must quarantine for 14 days from the date of last contact. (need to complete symptom monitoring form all 14 days and call OH)

• Any employee that tests positive (mild to moderate symptoms) must quarantine for 10 days from symptom onset AND until at least 48 hours have passed since symptom free. (need to complete symptom monitoring form and call OH)

You can View & Print the CoVID Symptom Monitoring Log. All staff must call OH and provide the CoVID Symptom Monitoring Log to clear to RTW as all of these cases are tracked and must be reported to multiple entities. Please send all returned symptom logs to OH via fax/interdepartmental mail/ email/ or under the HR door.

You can View & Print the Ill/Travel Questionnaire that may assist supervisors/charge staff in the process as all this is needed for reporting purposes. In urgent situations the HS has my contact info or I am also on Tiger Text.

Wishing everyone a very blessed Christmas! Thank you for all you do!

Janelle Hesse, RN, BSN | Manager, Occupational Health

NW Patient Portal

We can now direct patients to access their send-out labs results on the NW Patient Portal! At the moment, this is only available for patient 18 years and older. We are working with the hospital to make it easier for parents/caregivers to sign up. We can give the patient the NW Patient Portal handout with a QR code so they can watch a quick video to sign up.

Hopefully this will help patients access their results quicker and decrease the number of phone calls.

Updates

GST Expansion: Why:   GS is overrun, ideally we can work ESI 4s and 5s out of the lobby but it is becoming a regular occurrence that we can’t get the 3s into rooms due to volume.  It is necessary to make few changes while the volumes are high.   I approved this through plant engineering and IP.  There is a policy that specifically supports it which you can find on Policy Tech: IC005 Contact, Droplet, and Airborne.  We will need extreme diligence in compliance with two patient identifiers and all lab samples shall be labeled at bedside.   Confer with your CN about patient placement for anything questionable; we are well versed in the symptoms of covid and other infectious processes and will be purposeful in not placing patients at risk.

Rooms 1,4, and 6 will become double occupancy rooms.  Cerner is unable to make an A and B or other identifier for these rooms.  We will place a curtain down the center and are procuring double regulator wall inserts for the oxygen.   We are seeing if we can split the call light and have two of those as well.

We are adding 2 hall beds by room 3 and 4…. I know this doesn’t make sense without a long explanation but our only choice is to call them ER08 and ER09 in Cerner.  This ticket has been placed.

US Gel: Both sites will be ordering and stocking our own ultrasound gel, which surprisingly is in short supply nationally.   The radiology / US  has requested that the FEDs not use their gel to ensure that it is available for their testing.

Diffusics catheters: Similarly, please let the CN know if we are short on Diffusics catheters as we should not be getting our supply from rad but rather stocking our own.   It is becoming an increasingly important and stringent requirement that CTs with contract will only be performed on patients with a Diffusics; therefore, please use these if there is any chance for a CT with.   I know they feel different to place and are not your favorite but I believe you will get more used to them the more you use them, I know I have.

New Staff:    several new faces have started showing up and there will be several more over the next month, please go out of your way to make them feel welcome as new jobs are intimidating and can be difficult transitions!  Brandon….think you can update the employee list with phone numbers you made!?

Tiffany Finch – RN traveler

Kathy Stanton – RN traveler

Teresa Decker – RN PT days

Marisa Deleon – RN prn days

Marcos Garcia – prn tech

Cassandrah (Cassie) Hatfield – RN FT nights

Selina Rael – prn tech

Ashley Biskup – RN traveler will be back in Jan, yay!

Emily Blanton – RN prn days

Lynzi Bragg – new grad RN pt nights with prior experience

Bethany Garcia – RN prn (happens to be Liz’s sister)

LeAnn Personett – RN pt nights

James (Rick) Baker – RN FT nights

Other changes:  Heather Mills will be going to FT days, Bobbie is now PT, Jenifer George and Lisa Garcia resigned, Jamie Randall has taken a job in Tulia where she lives.

We have ordered food for those working on Christmas day and will add an item for night.  Thank you for working the holidays, it is a difficult part of our profession!

Airgas

 Airgas comes every Thursday to fill tanks at both locations. I want to give you an explanation of how this works. The left regulator shows the psi therefore volume of the left set of tanks and the right regulator, the right set. You can ignore the middle gauge. If the left set are being used and become empty it will send a message / alert to the panel that staff see; this means that it has switched over to the other set of tanks and ½ is gone. There should still be several days of oxygen in the set it switched to, it is not an emergency to call Airgas but should be monitored. A leak or several high flow patients being held for extended times could deplete this quicker. Engineering on call at the hospital can come out and exchange tanks if we are in a bind. Call me if you have questions when this happens.

EMTALA Tips

Please follow the link regarding EMTALA compliance in the FED-

https://app.sparkmailapp.com/web-share/TuiEdvfGiUDw-uJazTd03n_AnqjRjMCb2xtPD_Ox

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA
Emergency Medical Treatment & Labor Act (EMTALA) | CMS

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide ...
www.cms.gov

let me know if you have any questions or concerns
Thanks!!

✨Tiffany Powers RN ✨
NWTHS ED/FED Educator
Tiffany.Powers@nwths.com

FED Registration Flow

Watch the video below regarding the new FED Registration Flow we will be implementing on January 3, 2022. We have trialed this and it works very well and tremendously helps the flow and communication between registration clerks with nurses and physicians. Below is the process:

• There will now be clipboards on the wall, under the light switch, in every room. These clipboards hold the form that registration needs to get the patient registered. When a patient is brought to the room, the tech/nurse/physician will hand the clipboard to the patient, instructing them to fill it out while they are waiting. This will cut out extra trips by the registration clerk just to hand the patient the form.

• When the physician has seen the patient, they will click the drop-down under “BA (Bed Assignment)” column on the tracking board and select “MD Evaluating”.

  • This signals the registration clerk that they can now go see the patient to discuss billing and payment collection.

• When the registration clerk has completed everything they need with the patient, they will click the drop-down under “BA (Bed Assignment)” column on the tracking board and select “None” - which makes that entry blank again.

  • This signals the nurse that registration is done with the patient.

• When a patient is discharged and the house is on the board, nursing must wait until “MD Eval” has been removed by the registration clerk before the nurse can send the patient out.

It will take some getting used to for this process, but we have trialed it with different physicians, nurses, and registration clerks, and it has been universally praised for cutting down on extra trips by registration, cutting out the nurses having to ask registration if they are done, and improving our collections as well.

The physicians are the PRIMARY driver for this process to work - it is just 2 clicks for us to do but will make a huge impact on the flow and efficiency of the FEDs.

PRIORITY: TRIAGE

Team,

This is an extremely difficult time and we are seeing a much higher acuity, so I want to reiterate the priority of the initial triage as a safety concern for our FEDs.

What: If you scroll down below to Conrad’s email, this is a count of a rolling 2 hour average where the triage times are above 12 minutes. You’ll see that TSQ has the second highest of all UHS FEDs, GS third. I recognize that we are seeing more than ever and staffing is extremely tight; however, all the FEDs are experiencing these issues and placing triage as a priority. I believe together we can champion this issue and increase patient safety.

Why: It’s not about getting rid of a red plus or the corporate notices… that red plus represents a patient who hasn’t been triaged and could be a STEMI, Stroke or other critical situation until proven otherwise. It is an expectation that the initial triage will be a priority.

This is an example of a board. 3-4 of the patients in rooms were discharged before the patients were triaged out front. The initial triage should have been the priority as those patients are considered unstable until determined otherwise by triage whereas the patients being discharged home were known to be stable.

Reminder: CPs are now called as “Dr Hearts” overhead and all possible strokes get called as Code Stroke and go straight to CT

Thank you,
Andrea