C L I N I C A L A N D I N J U R Y P R E V E N T I O N A B S T R A C T S

expeditious manner. Currently, work toward improving offhour’s response time by having on-call personnel in house isin progress.

doi: 10.1016/j.jen.2004.07.048

10. ED Diversion Project. Flora Tomoyasu, RN, PHN, BSN, MSN,

CNS, Caron Hill, RN, BSN, Robin Durfee, RN, BA, CEN, CGN,

Saddleback Memorial Medical Center, 24451 Health Center Dr,

Laguna Hills, CA 92675

Clinical Topic: Nationally, 61% of emergency departmentsnever close to paramedic runs. This emergency departmenthad the highest rate of diversion (250 hours) in South OrangeCounty, California, from August 2001 to July 2002 mainlydue to both poor ‘‘turnaround time’’ (moving patients fromthe emergency department to inpatient rooms) and patientf low. This backlog of triaged patients (walk-ins) requiredparamedic diversion (back-door patients), leading to dissatis-faction for patients, physicians, and staff. ED diversion wasidentified as lost revenue because many of the patientsbrought by paramedics are admitted as hospital inpatients.The purpose of this project was to identify a process thatwould speed up ‘‘turnaround times’’ for inpatients, free upED beds, decrease wait times, and decrease paramedic diver-sion in accordance with a county-wide mandate to decreaseparamedic diversion.

Implementation: A multidisciplinary team identified barriers,developed a decreased diversion process, implemented theprocess, and monitored its effects. The barriers identified werestaffing, physicians, patients, environment, delivery systems,and technology/equipment. The plan (implemented in the fallof 2002) consisted of multidisciplinary education, admin-istrative changes, and an ED Diversion Tool. All departmentsinteracting with the emergency department were educated onthe barriers, solutions, and the importance of decreasing EDdiversion. All managers committed to supporting processesthat decrease diversion time, including teamwork approachesto moving patients quickly through the system, adding ahouse supervisor to monitor bed availability and patient f low,and requiring administrative approval prior to all ED closures.The ED Diversion Tool was used to daily track and monitorED diversion hours.

Outcomes: Diversion decreased (by approximately 50%) to145 hours in March 2003. A decrease in overall diversionat all hospitals was observed, although probably because allhospitals were working to decrease diversion per the county-wide mandate. One complication of keeping the backdoor open to paramedic receiving was the backlog of walk-ins. Turnaround time for admitted patients decreased by60 minutes; however, patient satisfaction did not change. EDwaiting room time doubled because all available ED bedswent to patients brought in by paramedics; walk-ins were seenlast. Patient dissatisfaction with long wait times caused ‘‘left-without-being-seen’’ numbers to rise, correlating with lostrevenue from these patients. Other problems are the increased(winter) patient volume and mandatory nurse staffing ratios.

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Historically, ED patient volumes increase during winter andare accommodated by creating overf low and hallway beds.Mandatory staffing ratios no longer allowed for this solutionwithout bringing in extra nurses, resulting in increased waittimes, saturation, and subsequent closure.

Recommendations: Back-door patients are now balancedwith walk-ins. A ‘‘Rapid Triage Protocol’’ is being developedthat allows physician order sets to be started on patients in thewaiting room (presenting signs/symptoms based). Hopefully,this will increase patients’ and physicians’ satisfaction byinitiating tests, having results available sooner, and increasingturnaround time by using wait time efficiently. Furtherevaluation of the effects of the new nurse staffing ratios andincreased patient volume on diversion time is needed.

doi: 10.1016/j.jen.2004.07.049

11. How to Get and Use Real-time Data to Improve CustomerSatisfaction. Susan Cook, RN, BSN, Fairfield Medical Center,

1101 Riva Ridge Blvd, Gahanna, OH 43230

Clinical Topic: The intent of this project was to increaseinternal and external customer satisfaction in the emergencydepartment. It was determined that there was a decreased levelof satisfaction among patients, staff, and physicians. Patientswere rating their satisfactions with their emergency depart-ment visit at 79%. The goal of this project was to raise patientsatisfaction level (regarding their ED visit) to 85%.

Implementation: Decreased satisfaction scores in the emer-gency department were identified. A committee of 8 staffmembers was formed to address customer satisfaction.Customers were defined as external (patients and theirfamilies) and internal (ED physicians and staff). Thecommittee developed 3 sets of 10 questions each for patients,physicians, and staff to rate their satisfaction on a scale of1 (poor) to 5 (most satisfied). These 3 groups were surveyedon a daily basis. The committee met weekly to evaluate thesurvey responses. Based on the responses, a ‘‘Goal of theWeek’’ was chosen to address the areas that need to beimproved. One example of a weekly goal was ‘‘Introduceyourself to the patient and family.’’ Each week the committeeevaluated the previous week’s goal and selected a new goal.

Outcomes: Customer satisfaction has improved in theemergency department. The satisfaction score rose from79% to 85%. The ‘‘Goal of the Week’’ is posted throughoutthe department as a constant reminder to help improvecustomer satisfaction. ED staff members assume ownershipfor customer satisfaction processes. The process is nowestablished and continues in this format.

Recommendations: Implementing this project to improvesatisfaction has been easy due to the weekly committee reviewmeetings and the daily data collection from the patients,physicians, and staff. Physicians and staff have becomecommitted to improving patient care and satisfaction.

doi: 10.1016/j.jen.2004.07.050

OURNAL OF EMERGENCY NURSING 31:1 February 2005