Improving patient care and efficiencies through multi-departmental collaborations.

Objectives: mproving patient care and efficiencies through multi-departmental collaborations Introduction Demands and the utilization of services of emergency departments (ED) and short stay observation units (EDOU) continue to increase by individuals without primary care physicians or health insurance coverage. Healthcare institutions need to develop ways to triage, treat and manage these patients in an effort to alleviate and avoid finding themselves in a gridlock with patients waiting for care in the ED. Material and Methods A need was identified to manage these patients that presented to the emergency department (ED) with chest pain/discomfort. Providing care to this patient population would need to be a collaborative effort between numerous departments and medical specialties. Once stakeholders were identified, the challenge of coordinating meetings would begin. As expected, everyone had their own idea of how to manage it. Option 1: Schedule staff to work half-day Saturdays to perform nuclear stress tests. This option was met with resistance from the physicians and the cardiac nursing team as they did not want to work on weekends. This caused the need for the development of an alternative plan. Option 2: Discharge these patients and schedule them to return for a nuclear stress test. It was determined that option 2 was potentially a viable solution and work began to develop a process. All patients presenting to the emergency department with chest pain would have a cardiac work-up. They would have an electrocardiogram and a series of cardiac enzymes performed. If all testing was negative, the patient would be scheduled to return the following Tuesday to undergo a myocardial perfusion scan nuclear stress test with either 99mTc sestamibi or a rubidium PET stress test. The patient’s BMI was the determining factor whether they would be scheduled for a SPECT versus PET stress test. Patients with BMIs greater than or equal to 40 would undergo a rubidium PET myocardial perfusion scan. Prior to discharge from the emergency department, the patients were provided with the description of the study, preparation for the study as well as an appointment. They were given ample time to have their questions answered. The insurance pre-certification team would then begin the process of trying to obtain authorizations. These studies were given priority status with the team in an effort to obtain authorizations prior to the patients returning as outpatients. Results For the first year of this program, there were 187 after-hour stress tests ordered. Of those, there were 60 refusals/cancellations/no-shows, just over 30%. Of the remaining 127 patients, approximately 8% had positive stress tests. These results are what we had anticipated seeing. Discussion Prior to implementing this procedure, patients were having to stay in the ED and EDOU until at least Monday so the cardiac testing could be performed. Not only was this an inconvenience for the patients, it also reduced the availability of beds for other individuals needing treatment in the ED/EDOU, especially since a vast majority of the testing were negative. Clinical Relevance/Application This process shows the value and importance of multi-departmental collaboration in streamlining patient care. Putting patient care first has provided patients with a better overall experience by decreasing their wait times and providing quicker discharges without compromising the quality of care received. An additional benefit to our facility has been to free up resources to allow us to provide services to additional patients without incurring additional staffing expenses. We will continue to work this process as a way to provide our patients with optimal care while decanting the ED and EDOU.