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Keeping the ER on Track


By MargaretAnn Cross, Contributing Editor September 2006
Three years ago, Long Beach (Calif.) Memorial Medical Center built a new emergency department, tripling its size. The department went from a "shabby and inefficient" space to a fresh, bright environment that has computers in every patient room and pods of workstations for nurses and physicians, says Carol Nachreiner, R.N., executive director of emergency services.

"We did everything new all at once-the Big Bang theory," she says. "It was quite a change going from a little 18-bed emergency department to a 53-bed megaplex that is very high tech and very electronic."

During the transition, the department replaced outdated patient tracking software that was no longer supported by its vendor. The new system, Amelior EDTracker from Patient Care Technology Systems, Mission Viejo, Calif., uses infrared technology and radio frequency identification to track patient, staff and physicians throughout the department and keep accurate records on which rooms are being used.

For the first time Long Beach Memorial could run reports to show how its emergency department was performing, Nachreiner says. The bad news was that it found it wasn't meeting its operational goals.

"We knew our volume was growing, and we knew we weren't efficient in our care," Nachreiner says. "But we didn't know how inefficient we were because we didn't have ways to collect data, other than chart review.

"The new system gave us a huge baseline of data," she explains. "It gave us a snapshot of the department any time we chose to look. It told us how long people were waiting for more than 15 different milestones."

Long Beach Memorial's goal, for instance, is that patients see a triage nurse within 15 minutes of arriving at the hospital. In examining early data from the tracking system, Nachreiner found that patients were actually waiting an average of one hour and 20 minutes.

"This is a parameter that is very important to emergency departments across the country, and until then, we didn't know where we stood," she says.

The hospital formed a committee to look at triage procedures. They redesigned the triage area and added an extra triage nurse during busy times. Having hard evidence about the problem won them support from management for their efforts and the extra resources that they needed to get the waiting times down, Nachreiner explains. Today, patients wait an average of nine minutes before seeing a triage nurse.

The patient tracking system also enabled Long Beach Memorial to set and meet a goal of having "fast track" patients-those with colds, flues and other easily handled problems-be in and out of the emergency department in two hours.

When they started the project, these patients were going through in about four hours. "There is really no reason for our fast track patients to wait half a day with a splinter or some other minor problem," Nachreiner says. "The tracking system gave us the data we needed to refine our processes. Data is power, and this system provides all the data you could possibly use to help your team pick out where the major problems are and put your resources where they are needed the most."

Tracking patients

As soon as patients arrive at Long Beach Memorial's emergency department, they are given badges that emit infrared signals, similar to a television remote.

The badges, which are placed on the patient's clothing, send signals every three seconds to sensors placed throughout the ceiling of the emergency and radiology departments. The sensors forward the signals to hardware devices that convert them into the badge numbers the EDTracker software understands.

Nurses and physicians sign into the system when they arrive and receive badges to wear for their shift or visit.

If the data being transmitted indicates that someone has changed location or that a provider has entered a patient's room, the software creates a time stamp and logs the change or encounter into the system. In this way, staff using the system can also see which providers are taking care of a patient.

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