Creation of an EMS Throughput Initiative in Order to Decrease EMS Wall Times

Aim: :

Background: EMS volume accounts for approximately 30% of our total patient volume. EMS wait times greatly impact community response times and facilitating EMS units to get back into service to be available for the community is pivotal. No standardized process for initiating care for EMS patients who are waiting for ER room placement.

Aim: Creation of a consistent EMS offload process to improve patient flow of EMS patients and to expedite EMS units going back into service to be more readily available to the community. To decrease EMS wall times so EMS units can respond quicker to critical patients (ie patients who meet trauma, stemi, stroke, sepsis alert criteria). To improve throughput and initiation of care for EMS offload patients waiting for bed placement after care is transferred to ER staff from EMS personnel.

Framework:: The Plan-Do-Study-Act guide was used to guide this quality initiative

Setting:: A teaching, urban level II trauma, comprehensive stroke, certified comprehensive cardiac care center located in the Southeast with a 633 inpatient bed capacity.

Stakeholder Team:: Vice President of ER assisted in collecting EMS data.
ER leadership assisted with obtaining equipment needed for EMS offload area and assisted with staff education during shift huddles.
ER patient flow coordinators conducted education and ensured process was followed during roll out.
Project champions consisted of selected ER staff members who assisted in educating staff during process rollout.
ER EMS coordinator assisted in education of new process to members of EMS leadership.

Methods: : Creation of a standardized EMS offload process to facilitate getting EMS units back into the community. Prior to this quality initiative, there was no standardized EMS throughput process. Creation of this process was to ensure EMS throughput would be expeditated and be able to be back into service sooner to better serve our community. A 22 bed capacity EMS offload process was initiated after receiving buy in from necessary stakeholders. Two EMS triage nurses were designated to assess and assume care of all EMS patients arriving at our facility. EMS triage nurses would facilitate their placement into designated offload areas if no ER room would be available. Designated offload areas would be staffed by ER staff members and care would be initiated on these patients while waiting for room placement.

Outcomes:: AVERAGE EMS UNITS MONTHLY
PRE-PROCESS AVERAGE:2781
PRELIMINARY RESULTS AVERAGE: 3094

AVG WALL TIME IN MIN
PRE-PROCESS AVERAGE; 30.16
PRELIMINARY RESULTS AVERAGE: 15.56

MEDIAN WALL TIME IN MIN
PRE-PROCESS AVERAGE: 16.85
PRELIMINARY RESULTS AVERAGE: 10.08

EMS UNITS WAITING OVER 60 MIN PER MONTH AVERAGE
PRE-PROCESS AVERAGE: 337.75
PRELIMINARY RESULTS AVERAGE: 106

Implications:: Our preliminary data has shown that the EMS offload process has been successful in decreasing EMS wait times at our facility by expediting EMS throughput. This process has standardized offloading EMS patients who are waiting for room placement and expedited getting EMS units back into service. Patients are also assessed sooner and have their care initiated by ER staff while waiting for room placement.