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Wednesday, December 31, 2008 9:00 AM
Newscast: New Toolkit Helps Hospitals Provide Safer, Efficient ER Care

(opening music)

Rand: This is Healthcare 411 for the week of December 31, 2008.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. I’m Debra James.

Rand: And I’m Rand Gardner.

Debra: Coming up:

Rand: New data on hospitalizations related to mental health treatment.

Debra: Plus, we’ll tell you about a new toolkit designed to help clinicians improve patient flow in hospital emergency departments.

Rand: And tips for navigating the health care system. This week we’ll look at questions you should ask when getting medical tests.

Debra: It’s all coming up on Healthcare 411.

[Begin PSA: Screening Tests for Healthy Living]

Rand: Here’s another health tip from AHRQ. Screening tests are a great way to catch health problems early, when they’re easier to treat or control. Talk with your doctor about screening tests for diabetes, breast cancer, high blood pressure and other conditions to see which ones apply to you and how often you should be tested. Learn more online at healthcare411.org. A message from AHRQ, the U.S. Agency for Healthcare Research and Quality.

[End PSA]

Rand: Now the numbers.


Rand: One in five hospital admissions are for patients with mental disorders. AHRQ research shows more than about one and half million hospital stays in 2006 were for patients admitted for treatment of a mental health condition. However, in an additional 7 million stays, patients were admitted for other conditions, but also had a mental illness. The most common mental illnesses are depression and bipolar disorder, which is also known as manic-depression.

Debra: A new toolkit is designed to help clinicians improve the way they deliver care in hospital emergency departments. The toolkit, called "Door to Doc," calls for safer, more efficient triaging and moving of patients through the ER. Health care executive and project facilitator Twila Burdick is with us to explain this project, which was sponsored by the Agency for Healthcare Research and Quality as part of its "Partnerships in Implementing Patient Safety" grant program. Welcome.

Ms. Burdick: Thank you.

Debra: Tell us a little bit about the "Door to Doc" Patient Safety Toolkit.

Ms. Burdick: Thanks for asking. Our project focused on improving how patients move through the emergency department. We wanted to deliver safer care for our ED patients by preventing them from leaving without treatment. We had a problem at our facility, so we decided that it was time to improve the process in our own facilities, and based on that work we developed a toolkit, called "Door to Doc," that we use here at Banner Health. Banner happens to be a large, integrated health system based in Phoenix, Arizona. We had partners in our effort: we worked with Arizona State University to actually help reduce the time that it takes for patients to be seen after they arrive in the ED. The toolkit was designed to be used by doctors, nurses, pharmacists, administrators, anybody who works in and with emergency departments. It includes training aids, some redesign principles, and some project management tools.

Debra: So then what kind of tools or suggestions does the toolkit specifically offer?

Ms. Burdick: Very generally speaking, we took a new look at how patients flow through the emergency department and decided that we could split them into those patients that are "less sick" and those patients that are "sicker," and when we realized that, we then devised processes for each of these groups to move through the ED. This really dividing up of patients in the ED was based upon what we call a "quick look" or assessment of the patient as they arrive in the ED, rather than a full-blown triage. This has the advantage of keeping our less sick patients, which we found to be the majority, flowing through the emergency department rather smoothly, instead of waiting in the lobby during our busy times. In the patient flow process for these less sick patients, we are now able to move them among the treatment areas, much as they would in a clinic setting, rather than having them sitting in an ED bed during their whole time in the emergency department.

Debra: What else will interested clinicians find in the "Door to Doc" toolkit?

Ms. Burdick: The kit includes tools for implementation, such as capacity and staffing planning, which are really important for managing an emergency department. It also includes a scorecard, so that we can define and monitor the performance of the ED, ensuring that the process changes are really working for the emergency department, the hospital, and really the patients that we’re trying to serve. It happens to be an interactive toolkit, which allows any facility that’s using this toolkit to enter their own data and that helps them then model the impact of these changes that we’re suggesting on their own service times.

Debra: Can you give us an example of where this toolkit has worked?

Ms. Burdick: Sure. Banner Health has been able to reduce the rate of patients leaving without treatment in our EDs by more than 35 percent, and this has happened in our 8 busiest Emergency Departments. But we’re not alone in using this process and using these tools. In fact, Ochsner Health Systems, a system located in New Orleans, has also used the toolkit in its flagship hospital in after the hurricane struck and left them capacity-constrained and has had similar success.

Debra: Thanks for joining us and telling us about the "Door to Doc" toolkit.

Ms. Burdick: Well thank you for highlighting this project; it really has been a wonderful project, we’ve learned an awful lot, and frankly we’ve helped a whole lot of patients have a better experience in the ED, which is terrific.

Debra: To access the "Door to Doc" toolkit online, go to ahrq.gov/qual/pips.

Debra: Up next, tips for navigating the health care system.


Rand: Your doctor orders a blood test or X-ray and you don’t really understand why. Do you ask? AHRQ Director Dr. Carolyn Clancy says it’s important to speak up and ask questions, so you get the best results from your health care.

Dr. Clancy: It’s important to discuss with your clinician ahead of time why the test is being done and how accurate it’s likely that the results will be. For example, sometimes a test is done for the purpose of answering a "yes or no" question, "do you have a specific condition" and the test results will be very reliable. You can be reassured if the answer is "no" and know what’s going to happen next if the result is positive. Other times tests are the first in a series of steps to try to find out precisely what’s going on.

Rand: Besides understanding why I need the test, what are some other reasons I might need to ask questions?

Dr. Clancy: To help make sure you get the most accurate test results, it’s important to follow all the directions as they’re given to you, and it may be important for you to know which lab that you’re going to be going to ahead of time, and if they have any specific requirements or recommendations for steps that you need to take before you come in for the test.

Rand: So what kinds of questions should I be asking?

Dr. Clancy: You need to know how the test is going to be done. Is this going to be a straightforward blood test? Is it just going to be something where your finger is pricked? Is it some kind of breathing test? What exactly will be happening to you? Do you need to do any preparation ahead of time, or will there be some potential side effects which might mean that you couldn’t go back to work right away?

Rand: Is there any thing else I can do to be safe when I have a medical test done?

Dr. Clancy: Another step that you can do is when you go in to get tests, there will be labels with your name for specimen tubes, for papers that are being sent to the laboratory or to the x-ray facility, and so forth. It’s very important to make sure that your specimens actually have your name on the particular tube or pieces of paper and so forth.

Rand: So I’ve had my test. What happens next?

Dr. Clancy: It’s very important that you know the results of any test that you have done even if you see a clinician who is of the "no news is good news" school of thought. By making sure that you know the results, you will also be reassured that the results didn’t get lost and that no news really meant that no results or information was passed on rather than the right results were obtained. You can absolutely get a copy of your test results to keep and many clinicians do this routinely. Others will be delighted to do so if you ask. I’m Dr. Carolyn Clancy and that’s my advice on how to navigate the health care system.


Rand: That’s it for this week. For more information on these and other health-related stories and topics go to healthcare411.ahrq.gov

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Rand Gardner, I’m Debra James. Please join us for the next edition of Healthcare 411.

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