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Increase the Rate of Service

The basic principle here is standardized workflows to decrease non-value added time by workers: always consider practices that are better for the patient but easier for the people doing the work. Avoid overproduction of patients (e.g., unnecessary testing).

Strategies for increasing the rate of service:

  • ? Cohort patients in one location to avoid movement. Assign staff to this area who have a passion for psychiatry.
  • ? Avoid unnecessary lab testing.
  • ? Have all supplies needed to care for patients and an area for belongings close by.
  • ? Move a medication dispensing station to the area for medication administration.
  • ? If call centers are used, have them present the patient to multiple locations simultaneously.
  • ? Create a standardized charting template so staff can spend more quality time with patients and be more productive.

Reduce Variation in Service

It is impossible to remove all variation since there is such diagnostic diversity in this patient population. That said, there are ways to minimize variation:

  • ? Agreements between psychiatry and ED physicians for initial medication by diagnosis
  • ? Standardized arrival processes for patients
  • ? Templates for charting
  • ? Agreements with local inpatient psychiatric hospitals on streamlined admission processes
  • ? Agreements between ED, therapist, and psychiatrist on who performs each aspect of care
  • ? Morning rounds with a checklist to ensure all patients get excellent care and no medical or psychiatric concerns are missed

See Chapter 5 on care options and treatment teams for a detailed discussion of how this will work in an ED psychiatry program.

Reduce Variation in Arrivals

This will require some creativity in emergency psychiatry arrivals. As we discussed before, arrivals occur in a Poisson process so not much can be done for ED arrivals except partnerships with law enforcement and local agencies to provide access. There can, however, be decreased arrivals to other queues that the patient goes through. An excellent example is unnecessary lab testing. If we avoid this, it creates a more standardized process with less variation in blood draws to this server.

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