Under the government grant, Burdick's team created a free toolkit to allow hospitals and health systems to replicate the program. It contains resources for implementing operational changes including the Door to Doc split flow process, interactive spreadsheets that use queuing for patient flow, multidisciplinary training aids and methods, a plan for managing implementation, and project management tools.
Teri Johnson-Kelley, MSN, RN, CEN, the director of nursing for the ED at Banner Estrella Medical Center in Phoenix, used the Door to Doc process in her department. Banner Estrella's 34-bed ED saw 92,400 patients in 2011, though it was designed to handle 74,000 patients when it opened in 2004. Johnson-Kelley recounts that within two weeks of opening, ED volume hit 50% over the anticipated census.
Yet there was no money to expand the department or staff. "Unfortunately the other side of the house was empty," she says. "We didn't have a lot of surgeries yet or other things in the community that usually feed a hospital&mdash:the ED was the front door."
With an overabundance of patients, wait times grew long; Johnson-Kelley says it sometimes took 6-8 hours for patients to be seen, which led to staff concerns about patient safety. The hospital leadership soon decided it had to get creative about how it saw patients. Banner Estrella partnered with Arizona State University's College of Engineering to find ways to maximize throughput. The result was the split flow model.