Assessment Tools for the ED

If you are interested in improving the operation of your hospital's Emergency Department, there are many tools you can use, some of which have been used by hospitals in Wisconsin.

The Culture of Safety Survey is a purchased survey through Mayo Clinic's Quality department.  Mayo Clinic Health System initiated a quality improvement process in their emergency department setting in response to a variety of concerns:

  • Patient complaints and low satisfaction scores, especially regarding delays in admissions and the perception of being arrested due to the monitoring system;
  • Safety concerns, both staff injury and rate of restraints usage;
  • Staff dissatisfaction;
  • Security consultant report;
  • Recognition that current system was not meeting patients needs.

Mayo Clinic Health System initiated an analysis using a variety of tools for assessing points in the system where quality was not adequate. The process involved the ED, behavioral health staffs, security, social work and the quality department. One finding was that a behavioral health diagnosis was either primary or secondary in 27% of ED visits.

Changes were made in a variety of areas:

  1. Environment: improved safety and security features in the ED;
  2. Personnel: redesigning the role of security staff to a back up and providing training on behavioral health; providing four hour training to all ED techs; creating a behavioral health liaison RN role.

The BH RN works from 4pm – 2am and was able to provide the following functions:

  • Expertise for BH assessment and intervention
  • Consultation; not primary RN for ED patient
  • Assesses BH issues and impact on presentation that the traditional ED RN does not have to do.

The result of these changes included:

  • Improved patient satisfaction;
  • Less security time in ER;
  • Increased staff comfort and skill level in dealing with BH patients;
  • A 23% overall improvement in staff perceptions and attitudes toward BH care!

For more information contact:
Karlene Phillips | Director | Inpatient Behavioral Health Services | Phone: 715-838-6752
Mayo Clinic Health System | 1221 Whipple Street P.O. Box 4501 | Eau Claire, WI 54701 |

Failure Mode Effects Analysis (FMEA)
"Failure Modes and Effects Analysis (FMEA) is a systematic, proactive method for evaluating a process to identify where and how [a process] might fail, and to assess the relative impact of different failuresin order to identify the parts of the process that are most in need of change."

Lean Institute
Kaizen Institute - "Kaizen Institute USA is a part of a global team of experienced Lean professionals with a passion for reducing waste, creating measurable improvements, developing people and enhancing customer delight."

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