Northwestern Medicine’s clinical operations team focuses on enhancing the care delivery model in the face of ever-present Emergency Department challenges, particularly with Emergency Department crowding and the care of vulnerable patient populations. Through redesigned patient flow, innovative programs and improved care coordination and community relationships, the operations team strives to advance the care for patients in the Chicagoland area.
In 2019, Northwestern Memorial Hospital was accredited as a Level 1 Geriatric Emergency Department, the highest tier of GED accredited by the American College of Emergency Physicians.
The accreditation is a testament to the work of the Geriatric Emergency Department Innovations (GEDI) program which began in 2012 with support from the Davee Foundation and a Centers for Medicare and Medicaid Services Health Care Innovations Award. The GEDI program consists of a multi-disciplinary team spearheaded by transitional care nurses, which includes social workers, pharmacists, physical therapists, and occupational therapists who work as a team to improve the care of older adults in the Emergency Department (ED). The GEDI team works to identify geriatric syndromes and risks and work to returning older adults home safely following care in the Emergency Department. Importantly, the GEDI team communicates with outpatient clinicians and performs follow up phone calls with patients to ensure that they are receiving the proper care when they are discharged.
The GEDI program has seen a sharp reduction in hospitalizations among older adults. In a study published in 2018, patients who had care coordinated by a TCN were admitted 36% of the time, compared to 53% of matched comparison patients who did participate in the GEDI program.
With the success of the GEDI program, Dr. Dresden was awarded an R01 in 2019 from the Agency for Healthcare Research and Quality to further study the benefits of the GEDI program for patients, including measuring the impact of GEDI on patients Health Related Quality of Life.
Emergency Department Projects
The spirit of interdisciplinary collaboration that pervades Northwestern creates a dynamic and ideal environment to conduct administrative and operational research. Current projects include:
- Alternative Care Pathways – A comprehensive workstream targeted at reducing inpatient hospitalizations and expediting safe, effective, and patient-centered care in the ambulatory setting. Existing alternative care pathways include a Low-Risk Chest Pain Pathway and a Neurospell Pathway for patients with symptoms of TIA or related neurologic symptoms. Current alternative care pathways in the process are Low-Risk Pulmonary Embolism and Atrial Fibrillation pathways.
- Intermediate Risk Chest Pain Pathway - In the first month 13 patients were placed on the pathway with 85% of patients completing the ESE and Cardiology testing within 72 hours. This initiative has received very positive feedback from patients due to the rapid access to stress testing and a Cardiologist.
- Low-Risk Check Pain Pathway - Over the past 2 years, over 700 patients have been placed on this pathway
- Telehealth Solutions – To promote safety and minimize risk in the setting of COVID-19, we have initiated ED-based telehealth solutions to provide patients with expedited care and promote patient and staff safety.
- Discharge Process Optimization - Currently implementing a comprehensive process improvement initiative to optimize the process of patient discharge from the Emergency Department to maintain patient privacy, promote understanding of an individualized, patient-centered home care plan, and enhance the patient experience of their ED visit.
- Virtual Rapid Cycle FMEA - To improve the quality of care of our patients boarding in the ED while awaiting an inpatient bed.
Academy for Quality and Safety Improvement (AQSI) Projects
- Reducing opioid prescription from the Emergency Department
- Identifying gender disparities in Emergency Department radiology turn-around-time
- Improving the evaluation of patients with a head injury and clinical suspicion for a concussion who present to the Emergency Department
- Identifying of fragility among elderly trauma surgery patients and implementing interventions to improve outcomes
- Reducing unnecessary blood culture for CAP, cellulitis, and pyelonephritis
- Standardization of sedation usage post-intubation beginning in the Emergency Department and continuing in the MICU
- Creating a formal protocol for the care of patients with sepsis and septic shock presenting in the Emergency Department
- Improving the timeliness of care for patients with neurologic emergencies presenting in the Emergency Department.
- Establishing safe and efficacious use of conscious sedation in the Emergency Department