Caryn Asbell, Kirstin Osborn, Sarah Rautio PROGRAM NAME: Hurry Up and Wait PROGRAM SCOPE: City of Centreville,

IL and surrounding municipalities SITUATION: In the Emergency Department of Touchette Regional Hospital the average wait time is 314 minutes before being seen in the E.D. 1 and 117 minutes before being transferred to an in-patient room.1 GOAL: Decrease the average wait time in the E.R. of Touchette Regional Hospital to 90 minutes over the course of six months from implementation date of Hurry Up and Wait program.
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INPUTS

ACTIVITIES

OUTPUTS

SHORT-TERM OUTCOMES

INTERMEDIATE OUTCOMES

LONG-TERM OUTCOMES

OVERALL GOAL

ER Staff - Doctors - Nurses - Patient Intake - Other Staff Funding - Grants - Program Budget Time - 6 Months Education Materials - Pamphlets - Manuals - Seminars Technology - Internet website - Computers - Social Networking Facilities - Touchette Regional Hospital E.R.

Needs Assessment - Distribute written survey to physicians, nurses and other staff - Distribute written and telephone surveys to previous ER patients - Create educational materials/seminars

Preparation - Surveys distributed to 500 TRH staff - Surveys distributed to 5,000 St. Clair County residents - 1,000 Educational materials finished (pamphlets, manuals, and training courses) Educational Program - Materials handed out to 100 employees - Conducted 6 training seminars (90% of employees attended) - 85% of survey respondents had ER wait times of 3 hours or more Implementation - Added 10 ER beds - Increased staff by 25% per shift - Increase triage stations from 1 to 3 - 1 centralized supply station added - 40 ER staff receive survey - 5 simulation scenarios created for staff

(Within 2 Months) Minimum: Staff has received their surveys, residents have received their surveys, and educational materials are starting to be distributed Minimum: 50% of All of education materials are handed out to employees and they start reading them Minimum: 25% of staff has attended a training seminar Beds are being added to the ER and staff can see a decrease in wait times All new staff has been added and patients are giving better reviews Patient satisfaction increased by 30% and they are giving better reviews of the hospital

(Within 4 Months) Minimum: All of the staff and resident surveys are coming in and have been completed, all educational materials have been distributed Minimum: 75% of all educational materials were handed out to employees and have started giving opinions on them Minimum: 65% of staff has attended a training seminar All beds have been added to the ER and staff has seen a substantial decrease in wait times New staff has been added as well as all triage stations are running Patient satisfaction increased by 60%

(Within 6 Months)

(In Years to Come)

Educational Program - Distribution of program materials - Educate staff regarding speed of service - Process survey results

Touchette Regional Hospital ED wait times will be reduced to 90 minutes or less within the six month time frame

Wait times in the ED are consistently below 60 minutes and less than 10% of patients have an unsatisfactory experience in the ED of TRH

Implementation - Put Hurry Up and Wait program into effect - Survey and interview staff on program effectiveness - Make changes based on results

Patients experience greater satisfaction with emergency room visits at TRH, 75% of patients report a high satisfaction rating

1 According to the Emergency Care Throughput Measures (www.medicare.gov) 2 Touchette Regional Hospital is abbreviated TRH 3 Program name Hurry Up and Wait is abbreviated HUAW 4 Results for average ER wait times are recorded at 2, 4, and 6 months

Caryn Asbell, Kirstin Osborn, Sarah Rautio

Assumptions
This program is assuming that those participating in the program have a common goal to decrease the wait times in the ED of TRH. It is also assumed that the hospital has the resources available to properly administer this program as suggested by the logic model. It assumes that TRH has correct research and educational materials available and that patient will be more satisfied with reduced ER wait times.

External Factors
Natural disasters could cause a large increase in ED traffic that could result in wait times greater than 90 minutes. This could cause skew of data and affect the results of program effectiveness. The state of the economy could also cause TRH to have to make cutbacks on what parts of the program can be implemented. Items such as these would be documented in the results section of the program.

Needs/Needs Assessment
Needs Assessment Questions: 1. Does the emergency department at TRH have enough resources including medical staff, other staff, floor space, medical supplies, and funding, to increase the number of ER beds by 10, sustain additional staff per shift, and add two triage stations to the ED? Before implementing the Hurry up and Wait program, what is the average wait time for a patient entering the ED of TRH? Is the extensive wait time of TRH emergency department affecting the satisfaction of our patients? Data Collection Plan In order to determine the need for an increased number of beds, more staff, and two additional triage units, the Needs Assessment will consist of a written employee survey, a written patient survey and a telephone patient survey. The administrators of Touchette Regional Hospital will be responsible for distributing and collecting survey results. For our program, HUAW, the employees and patients will have one month to finish and return the survey, then data will be analyzed and assessment will be completed. The needs assessment provides data correlating patient satisfaction with ER wait times, as well as ER staffs capability to expand the ED. 5. Employees 1.

Process Evaluation
Process Evaluation Questions: How many employees feel that the ER wait times at TRH have been reduced due to the program implementation? To what extent? What portion of employees has completed program training? How many employees feel that they have an increased understanding of how to be more time efficient in the ED? How many employees feel that TRH should continue to use the Hurry Up and Wait program for the ED? How do the ER wait times at TRH compare to hospitals in the surrounding area?

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Patients 1. 2. How many patients are satisfied with the current wait times at TRH and will continue to use their ED in the future? How many patients have returned to the ED at TRH since HUAW program implementation and have experienced a reduction in wait time?

1 According to the Emergency Care Throughput Measures (www.medicare.gov) 2 Touchette Regional Hospital is abbreviated TRH 3 Program name Hurry Up and Wait is abbreviated HUAW 4 Results for average ER wait times are recorded at 2, 4, and 6 months

Caryn Asbell, Kirstin Osborn, Sarah Rautio

Process Evaluation
Indicators Hospital administration are responsible for distributing educational materials, conducting seminars, implementing HUAW program, and keeping records of employee training participation. The administrator successfully completed employee training with 50% of the staff within the first month. After HUAW program implementation, doctors, nurses, and other staff collaborated together to introduce the two additional triage stations and 10 additional ED beds. Average ER wait times after 4 HUAW program implementation are recorded and compared against previous ER wait times. Triage station preparation and employee training are completed by the end of the second month. All 10 ED beds have been added to the ED as well as the two new triage stations. Instruments Surveys and employee interviews are used to record decreased wait times in the ER. TRH administration was held accountable for ensuring employee compliance and enforcing guidelines. Documentation by hospital administration is utilized to ensure employees have completed training and understand procedure. The financial budget shows record of the additional supplies, beds, and employee hours needed to effectively increase ED function. Evaluation Design 1. 2. -

Outcome Evaluation
Outcome Evaluation Questions Were ER wait times decreased to an average of 90 minutes or less? Was there enough patient traffic through the ED to keep additional beds and triage units functioning regularly? Are the additional costs monthly related to HUAW implementation manageable with the amount of patients seen on a per month basis? Did the program increase patient satisfaction while simultaneously adhering to TRH policy, mission, vision, and goals? Indicators All employees are utilizing and maintaining additional ED beds, triage units, and centralized supply cabinets. Staff is becoming more accustomed to an increase in ED traffic. Staff is able to treat 30% more patients per 8 hour shift. Wait times in the ER at TRH were reduced by 35%. Instruments Surveys are to be used to measure employee participation of the program and patient satisfaction with ED changes. Simulations are used to ensure that medical staff is able to sustain with ED additions. Statistical data will be used to measure how much ER wait times were decreased by. Program directors will document the number of patients that

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One Group, Before-After Design Employee o O1O2O3O4 X O5O6O7O8

1 According to the Emergency Care Throughput Measures (www.medicare.gov) 2 Touchette Regional Hospital is abbreviated TRH 3 Program name Hurry Up and Wait is abbreviated HUAW 4 Results for average ER wait times are recorded at 2, 4, and 6 months

Caryn Asbell, Kirstin Osborn, Sarah Rautio

Observations of employee performance at the ED of TRH should be made several times before program implementation, during the program implementation, as well after the program has been completed. Data Collection Plan Healthcare managers at TRH will collect data from the employees in accordance to the wait times in the ED. The data included in their collection realm is written employee surveys, written patient surveys and observations of ED flow before, during, and after program implementation. This information will be collected weekly as it is received. Upper level administration should take the data received from these sources and compare ED activity to, increased costs, decreased wait times, and determine whether the program is effective in boosting patient satisfaction. Program directors are responsible for helping administration in distributing surveys, observing ED function, data collection, and data interpretation.

continue to have wait times over 90 minutes while the program is in effect. They will also document traffic through the ED and number of patients seen per shift. Evaluation Design One group, Before-After Design Patients o O1 X O2 Observations of patient satisfaction at the ED of TRH should be made before program implementation as well as after the program has been completed. Data should include how long the patients spent waiting in the ED and patient satisfaction with TRH ED. Participation by patients will be voluntary and data will be collected at will. Data Collection Plan Healthcare managers at TRH will collect data from the patients in accordance to the wait times in the ED. The data included in their collection realm is written patient surveys and telephone patient surveys. Data will be collected and assessed at the end of each month by program directors. Data will be collected and assessed at the finish of the program, which is 6 months in length. Data from pre-program, during program, and post-program will be analyzed and compared to determine if the program has been beneficial to the hospital. Hospital administration will be responsible for the compilation and analysis of this data.

1 According to the Emergency Care Throughput Measures (www.medicare.gov) 2 Touchette Regional Hospital is abbreviated TRH 3 Program name Hurry Up and Wait is abbreviated HUAW 4 Results for average ER wait times are recorded at 2, 4, and 6 months