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An Evolving Approach to Addressing High Volume



This winter, Lawrence General will roll out a number of new initiatives intended to enhance patient flow during periods of high volume. Building on existing measures that are activated when the hospital reaches Code Help status — that is, when more than 12 admitted patients have been waiting for a bed longer than three hours — the new Census Response Protocols take a broader and more immediate approach to expediting the patient progression process. The goal of each incremental step in the protocol is to trigger an escalating set of responses that prevent the hospital from reaching the next level. 

“Our existing Code Help policy focuses on volume surges in the Emergency Center, which is really just the tip of the iceberg when we are experiencing capacity issues,” says Karen Moore, RN, senior vice president of operations and chief nursing officer. “The reality is far more complex and requires a more proactive, hospital-wide response.” Thus far in 2017, Lawrence General has had 49 Code Help days, an average of almost one per week.

Developed by a multidisciplinary task force and informed by best practices gathered at professional conferences and site visits to other hospitals, the new Census Response Protocols leverage staff from across the organization to provide assistance when needed and makes better use of existing patient beds in underutilized areas of the hospital. The key themes for the initiative grew out of an Appreciative Inquiry retreat focused on enhancing the patient experience.

“We’ve made incremental improvements to throughput over the past several years and have shaved about 15 minutes off our average wait time for a bed, but from a patient safety and experience perspective, we know we need to do much better,” says Karen. “These new protocols will help us take it to the next level.”

Key components of the new Census Response Protocols will be rolled out in early 2018: 

Discharge Lounge: The lounge between Hamblet 4 and Russell 4 will be converted into a comfortable location with television and refreshments where patients who have been discharged can rest while they await rides home. Moving discharged patients out of inpatient rooms enables housekeeping to clean and prepare those rooms more quickly for inpatients who are boarding in the Emergency Center. 

Adopt-a-Unit: On days when the hospital has reached Code Help status, volunteers from non-clinical departments will pitch in on patient floors, answering call lights, fetching blankets, refilling water pitchers, and taking on other non-clinical tasks. This added help will allow nurses to focus on patient discharges and freeing up beds. 

Swing Beds: Ten beds— six in pediatrics, four in the ICU—have been identified as swing beds that can be opened or reallocated to meet peak demand. These beds will be made available as needed to patients who meet specified criteria.

Transition Beds: Four stretcher transition bed locations have been identified on Hamblet 4 and 5 (one each) and two on Russell 4 for those occasions when all other beds are full. During a Code Help, patients meeting specific clinical criteria can be assigned to a transition bed on a unit where a vacant bed is being prepared for their use. These transition beds are accepted by the Department of Public Health as an appropriate response to spikes in volume and will help free up space in the Emergency Center and provide a more private and quiet environment for patients. Additional nurses will be added when these beds are in use. 

“We are confident that this combination of responses will enhance patient flow on high census days and help us improve the quality of care, reduce risk to our patients, and enhance the overall care experience,” says Karen. “We will be monitoring the effectiveness of each component very closely, seeking feedback from staff, and making refinements as we move forward.”

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