Urgent Matter Collaborative

The Urgent Matter Collaborative is a program funded by the Robert Wood Johnson Foundation (RWJF). The program was formed to identify, develop, and share innovative approaches, inventions, and models to improve Emergency Department (ED) flow and quality of care. Urgent Matters Collaborative has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States.

One program they developed in November 2006 was the Fast Track program. The Fast Track initiative has shown excellent progress in quality of care and patient satisfaction. Their main objective is to prevent overcrowding within the ED. It is important that patients with urgent conditions be treated quickly and be discharged from the hospital.

The program shows hospital improvement because it reduces extensive waits and improves the overall flow of patients through the ED. This program allows physicians and other medical staff the ability to multitask by treating a fast track patient while waiting for results for a more seriously ill or injured patient. Furthermore, by implementing a fast track process it can reduce the overall length of a patient's stay and increase patient satisfaction.
Urgent Matter Collaborative-Fast Track within the ED supports the overall health care improvement. This program allows for efficient ED operations, shorter wait times, faster diagnosis, provides an overall better patient experience, and increases patient satisfaction scores. Fast track improves the overall flow by taking a lean approach. This approach can reduce overcrowding within the ED, which provides not only better quality of care but also the entire patient experience.
PAST IMPACT
“In 2008, Urgent Matters launched an 18-month, six-hospital collaborative learning network to improve patient flow and reduce ED crowding” (McHugh, M. 2010). Each hospital created a patient flow improvement team and implemented at least one improvement strategy. It was important to identify any barrier to the implementation of the patient flow and create improvement strategies to improve any barrier discovered.
Following the implementation, Urgent Matters conducted site visits to each hospital and conducted interviews with members of the hospitals' patient flow improvement teams. “A total of 127 interviews were conducted using a semi-structured interview protocol consisting primarily of open-ended questions. Interviews were recorded, transcribed, and coded using Atlas.ti” (McHugh, M. 2010). Estimates of time and expenses were determined for each strategy. Additionally, hospitals submitted three months of patient-level ED data to include the before and after implementation of strategies.
Across the six hospitals, “nine patient flow improvement strategies were proposed, and eight were implemented by the end of the collaborative” (McHugh, M. 2010). The most commonly reported barriers to implementation were staff resistance, staffing shortages, and challenges related to culture change. The most commonly reported facilitators were participation in the collaborative, executive leadership and support, and staff participation in the planning and implementation of the strategies. “Costs incurred during implementation ranged from $0 to $150,000; however, the majority of strategies required little (less than $200) or no new investment. Staff time spent planning and implementing the strategies ranged from 40 hours to 1,017 hours. The most time-intensive strategies were those that required extensive staff training. Three hospitals demonstrated a significant (p<.05) improvement in at least one throughput measure after the implementation of the strategies” (McHugh, M. 2010).
Even with a variety of roadblocks identified within the hospitals, the study shows that hospitals successfully implemented patient flow improvement activities under this study. Hospitals can implement strategies without incurring major costs. If other hospitals adopt similar studies they may be able to benefit and improve barriers within their hospital.
FUTURE PLANS
Urgent Matters continues to support ED quality improvement through webinars, e-newsletters, website and toolkit development, and increasingly through research. Recognizing that inpatient boarding is a leading cause of crowding and that barding is not always associated with a lack of inpatient beds, the Urgent Matters team is developing a survey that will help hospital leaders assess the culture of hospital transitions in care. This type of tools will aid hospital leaders as they seek to improve the patient flow.
Using the data collected through the learning networks Urgent Matters staff is collaborating with the faculty from the “Wharton School of Business at the University of Pennsylvania to develop a conceptual model of crowding” (McClelland, M.

2011). This tool will assist hospital to more accurately measure the effects of improvement strategies.

Few departments within a hospital influence the efficiency and effectiveness of other departments as much as the ED does. By demonstrating a commitment to high quality, efficient, patient centered care, the ED is strategically located within the hospital enterprise to demonstrate leadership for hospital wide quality improvement. Urgent care has facilitated and empowered EDs to get as change agents for important and will continue to do so in the years ahead.

This program will affect health care reform in a positive way. All hospitals have a need to address ED overcrowding. There are several reasons why ED overcrowding should be the forefront in improvement efforts. It is important to remember that ED crowding compromises quality of care is costly, compromises community trust, and patient flow throughout the hospital. It is important that ED leaders and other administrators show the ability to adapt, embrace change, anticipate its effects, identify strategies to improve ED overcrowding and be ready to face any challenges that arise. The Urgent Matter Collaborative has done an excellent job improving these issues and will continue to positively impact the health care

reform.
The Urgent Matter Collaborative will continue to be successful in the future and assist hospitals in reshaping the dynamics in the ED. They have done an excellent job recognizing the constant struggles and continue to identify, developed, and improve ED flow and quality. In addition to this, they have formed relationships with other organizations to help develop solutions to prevent overcrowding in the ED.
In conclusion, organizations and providers are making excellent strides in improving health care and patient satisfaction. It is important when insuring or prompting healthy patients, we must have strong health care systems in place. To deliver true evidence-based care, evidence-based management is necessary to support it. The information and data is vital to manage the patient and the system in place. Also, real time data is important for improvement in healthcare. Improved information and data will lead to better decisions and lead to better healthcare. I believe the services mentioned have made a positive impact on the health care system and we will continue to see improved patient safety, patient satisfaction, performance improvement, and improved quality of care in the future.