Yale New Haven Westerly Hospital Emergency Department

Westerly, Rhode Island

A strong partnership among stretcherside nurses, ED leadership, physicians and the medical information officer has driven substantial improvement in Yale New Haven Westerly Hospital Emergency Department’s sepsis care. Three years ago, SEP-1 compliance was 66.7 percent, prompting multidisciplinary efforts which included correcting an electronic documentation issue that affected blood-culture timing, improving laboratory communication and redesigning sepsis fluid-resuscitation orders to allow appropriate clinical modifications while maintaining compliance. Staff from the 15-bed ED collaborated with the system sepsis team to develop a sepsis timer integrated into the department’s track board, providing visibility of bundle metrics for the entire care team. These initiatives increased SEP-1 compliance to 78.13 percent, and recently, the department achieved three consecutive months of 100 percent compliance.

The team also identified provider handoff delays, transfer coordination challenges and bed management inefficiencies as barriers to timely admissions from the ED. Key initiatives to reduce the length of stay for admitted patients included monthly case reviews with hospitalist and ED leaders, creation of dedicated transport coordination processes, real-time audits of delayed ICU transfers and four-hour bed management huddles. These efforts resulted in median bed-assigned-to-inpatient-arrival time from 110 to 64 minutes and decreased the number of patients boarding longer than four hours by half.