Team-based Pod System Reduces Lengths of Stay for Treat-and-Release Patients.

To boost performance on a range of metrics, the 55-bed ED at NYU Lutheran Medical Center in Brooklyn, NY, transitioned to a pod system in August 2016. The approach, which is designed to foster team-based care, involves assigning physicians and nurses to designated geographic areas throughout the day, minimizing the movement of physicians as well as the need for phone communication. When coupled with other changes, including the introduction of point-of- care testing, the pod initiative has enabled the ED to reduce lengths of stay for all treat-and-release patients to less than three hours for the first time in the history of the department, according to administrators. There were multiple challenges involved with the transition to a pod system, including the need to match physician schedules with patient volume, but clinicians note the approach has produced improved physician-nurse communications. Administrators credit the creation of a process improvement team with giving frontline staff a voice in planned improvements while also facilitating the change process.

Pharmacist improves timely administration of medications to boarded patients in the emergency department.

PURPOSE: Our purpose was to assess the variations in timely administration of medications based on differences in nursing staff (ED nurses who are responsible for emergency and boarded patients vs inpatient nurses who are responsible for only boarded patients) and to determine whether a pharmacist's interventions can improve the timely administration of medications to boarded patients in the emergency department. METHODS: This was a prospective observational study. Patients were included in the study if they were aged 18 years or older, were physically located in the emergency department but had already been admitted to the medical center, and had medication orders. The pharmacist documented the medication orders and the allotted time for administration. Once the upper limit of the allotted time frame for administration had passed, the pharmacist determined whether the medications were given and interventions were then carried out for those medications that were not administered. Successful interventions were documented when the medication was given within 1 hour from the time of intervention. RESULTS: Seventy-nine patients were included in the study, resulting in 266 medication administration opportunities (emergency department, 146; inpatient, 120). Inpatient nurses administered medications in a timely manner at a significantly greater rate than ED nurses (83.3% vs 63.7%, P < .0001). The greatest difference was observed during the evening hours (95.2% vs 53.8% of medications administered for inpatient vs ED nurses, P = .002). The most common reason for medications not being administered by ED nurses was insufficient time (51.4%), and for inpatient nurses, it was that the medication order was not verified (77.8%). The pharmacist's interventions were successful with both the ED and inpatient nurses (95.5% and 94.1%, respectively). CONCLUSION: This study illustrates that assigning nurses with varying workloads as a means to manage overcrowding is likely to result in boarded patients in the emergency department not receiving their medications. ED pharmacists' interventions may fill the gap, ensuring compliance with the administration of medication orders prescribed for boarded patients and ensuring more timely administration. A multidisciplinary team approach is needed to manage current overcrowding issues.