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School of Medicine
Dome - They answer the call
They answer the call
Date: September 3, 2010
Keeping Suburban’s ED open for business falls on a hospital-wide team team that must quickly direct patient traffic.
When the Suburban Hospital’s ED reaches capacity, the department’s clinical director Gretta Cuccia leads a team that scrambles to find hospital beds for patients.
On the frequent occasions that Suburban Hospital’s emergency department was forced to divert ambulances to other area hospitals, the impact rippled beyond the ED to departments across the institution. Because 76 percent of Suburban’s admitted patients come through the ED, for example, closures limited their access to important specialties, including the hospital’s state-of-the-art cardiac surgery program.
That’s why Suburban caregivers who sought a way to improve patient flow in the ED knew the problem could not be solved within the ED alone. “It was a hospital problem rather than an ED problem,” says Cindy Notobartolo, division director for emergency and trauma services.
Enter CODE C, a preclosure alert process that relies on hospital-wide cooperation and communication. Since it was rolled out three years ago, the program has cut ED closures by 50 percent, thus drastically reducing diversion rates.
“Staff and caregivers don’t always think about the hospital as a whole,” Notobartolo says. “But CODE C really helped the departments communicate with each other. And it’s all in the best interest of patient care.”
Now when the ED nears capacity, the department charge nurse issues a CODE C page to designated contacts from the ICU and CCU, as well as admitting, housekeeping and transport services.“Everybody gathers and looks at the problem together and decides how they could most effectively get people up to the floors and take care of the folks in the ED, with the goal of getting more patients in and taking care of them,” Notobartolo explains.
Raising awareness about capacity
Gathered around a computer screen, the CODE C team seeks avenues for admitting more patients by looking at factors such as the number and type of current inpatients, bed availability and how many ED patients are awaiting triage.
CODE C conferences provide an opportunity to share firsthand information that also helps to move ED patients to the floors, says Greta Cuccia, clinical director for the Suburban ED. For example, Cuccia says, “A CCU charge nurse will say they have a patient who will be discharged shortly. Then, a housekeeping manager will make that bed a priority to clean, and the transport contact will put the discharged patient at the top of the list.”
To the benefit of the entire Suburban community, the program has spawned “awareness around the facility of what’s going on in the ED,” Cuccia says “I think the support gained from working with the other units is very empowering, not just for me, but for the staff nurses as well, because they’re heard,” she says. “People are paying attention to our needs, which is not always the case elsewhere. And it also makes the bedside nurses and the physicians feel better about the care they give and where they work.”
The process continues to improve patient flow. During the past fiscal year, there were even some months when the Suburban ED did not have to close at all, an admirable accomplishment for a hospital with a high acuity rate. That doesn’t happen every month, but for the past three years, Suburban has met its target for reducing closure times.
The preclosure alert process has also helped to reduce overcrowding at surrounding hospitals, Notobartolo says. “When one ED goes on Code Yellow, there’s a domino effect that affects other regional hospitals, as well. But now, ambulances are going where they’re supposed to be going,” she says.
Notobartolo also notes that some neighboring hospitals have been inspired by CODE C’s effectiveness to create similar procedures that have reduced closure times in those facilities.