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MID-TRACK

MID-TRACK. AHRQ Annual Conference September 27, 2010 Jeffrey Margulies, MD, FACEP. Why: Collateral damage. What: Identifying the Initiative. 2.4% LWBS (left without being seen) Drill Down reveals ESI 3 issue. Who: ESI 3 Conundrum. Patients are too complex for typical fast track visit

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MID-TRACK

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  1. MID-TRACK AHRQ Annual Conference September 27, 2010 Jeffrey Margulies, MD, FACEP

  2. Why: Collateral damage

  3. What: Identifying the Initiative • 2.4% LWBS (left without being seen) • Drill Down reveals ESI 3 issue

  4. Who: ESI 3 Conundrum • Patients are too complex for typical fast track visit • Not ill enough to be brought back immediately at times of high census • Result: highest LWBS rate for this subgroup of patients • Significant potential for morbidity

  5. Who: Identify your target!

  6. When: Do the math

  7. Where: Enter the Mid-Track • Create a solution to address the needs of the ESI 3 patients • Insufficient space in current ED • ASU located above ED and available after-hours • Challenge: find a process that works and uses ASU space

  8. How: Mid-Track Evolves • Concept: frontload patient visit • Nurse categorizes patient as ESI 3 • Refers to physician sitting in triage • Physician in triage, but not triaging • Only sees ESI 3 pts with 1 of 6 CC • Phlebotomy station set up near triage • After initial evaluation pts go up to ASU • Care coordinated with NP for entire shift

  9. Lessons Learned/Challenges • Process design quite challenging • Start time critical to front loading • Bolus of patients when MT starts at 4p • Pts ‘triaged’ to MT before 4pm • Cost • Staffing

  10. LWBS rates pre and post Mid-Track

  11. Collateral benefits • Positive response from patients • Favored by staff • Reduced stress levels in the ED • NP role better defined than previously • Hospital renewed focus on throughput • Mitigated our natural tendency towards procrastination

  12. Future of Mid-Track • Successful initiative to date • Expand hours and days of operation • Expand ESI 3 patient complaints • Included in new ED redesign

  13. Modern Healthcare

  14. Thanks to the team! • Charles Bové • Carol Butler • Curt Cicotte • Susan Dries • Mike Gewirtz • Kathleen Lock • Tom Nolan • Rob Sharma • Many others

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