Children’s Health Children’s Medical Center Dallas Emergency Department – Dallas, Texas
Dallas, Texas
Children’s Health Children’s Medical Center Dallas Emergency Department
The Children’s Health Children’s Medical Center-Dallas emergency department team developed waiting room reassessment guidelines that have contributed to
significant increases in patient reassessments and improved patient satisfaction.
This effort included clearly defined paramedic roles and responsibilities, as well as standardized frequency and elements of reassessments. Additionally, there is an escalation algorithm to facilitate timely interventions to enhance communication between triage and the waiting room and an electronic communication tool developed in EPIC. The guidelines included a comprehensive set of vital signs and a general assessment every two hours. During the six-month pilot period, 4,584 patients were reassessed in the waiting room. For patients waiting more than two hours, complete vital signs reassessment rose from 1 percent to 81 percent. General assessments increased from 39 to 74 percent.. Vital signs reassessments increased from 46 to 93 percent for patients waiting three hours or less. Recognition of acuity level changes also improved, with 100 percent of patients identified within the first 2.5 hours, compared to 27 percent prior to implementation. The left-without-being-seen rate dropped from 8.9 to 3.5 percent, and overall patient satisfaction improved from 61.9 to 72.8 percent.
significant increases in patient reassessments and improved patient satisfaction.
This effort included clearly defined paramedic roles and responsibilities, as well as standardized frequency and elements of reassessments. Additionally, there is an escalation algorithm to facilitate timely interventions to enhance communication between triage and the waiting room and an electronic communication tool developed in EPIC. The guidelines included a comprehensive set of vital signs and a general assessment every two hours. During the six-month pilot period, 4,584 patients were reassessed in the waiting room. For patients waiting more than two hours, complete vital signs reassessment rose from 1 percent to 81 percent. General assessments increased from 39 to 74 percent.. Vital signs reassessments increased from 46 to 93 percent for patients waiting three hours or less. Recognition of acuity level changes also improved, with 100 percent of patients identified within the first 2.5 hours, compared to 27 percent prior to implementation. The left-without-being-seen rate dropped from 8.9 to 3.5 percent, and overall patient satisfaction improved from 61.9 to 72.8 percent.