SKYLINE HOSPITAL AND MEDICAL CENTER

Nursing Service Division

Emergency Room Unit

BUSINESS PLAN
I. Overview

The show window of the hospital and the first point of patient’s experience in
the hospital is the Emergency Room Unit. Its function is to receive patients in need of
emergent medical assessment and management, prioritizing their needs; ensuring that each
patient is attended, stabilized to be safely discharged or to be endorsed to nursing units for
continuity of care.
The Emergency Room Unit is a 25 – bed urgent care area, comprised of different
services such as Medicine, Pediatric, Trauma – Surgery and OB Gynecology. It also includes
Minor Operating Room dedicated for selected minor surgical procedures and OB
emergencies. In addition, adjacent to the Triage Area is the Isolation Room for infectious
diseases for assessment and treatment of out-patient with communicable/ infectious
diseases. The Emergency room is staffed with highly trained personnel – Physician, Nurses
and associates to provide 24 – hour emergency services. Moreover, the area is equipped
with modern medical equipment and accessible diagnostic services to facilitate immediate
management of critically ill patient.
With the above mentioned facts, it is undeniable that:
1. The Emergency Room is the first area of patient’s contact/ hospital
experience. Thus, providing a pleasant and satisfying emergency care should
be provided.
2. Various Services is offered by the unit. Thus, completeness of supplies and
equipment is necessary. Including maintenance of appropriate number of
manpower.
3. The emergency room SHOULD be an income generating unit. Thus, proper
charging of supplies and services should be implemented.

II. Objectives

 To ensure continuity of holistic care provided to patients, though:

a. Availability and accessibility of services and service providers: immediate provision
of services should be emphasized that can be met only through availability of
complete emergency drugs, medical supplies, equipment and personnel.
b. Promoting a harmonious, organized and satisfying experience for each patient
experience/ contact, that can be met through a planned – functional, practical/
hassle-free and fast workflow that will be utilized in the unit.
c. Immediate response in attending patients, LESS WAITING TIME and FASTER
assessment/disposition/ turnover.
 To ensure that unit meet its target of being the center for revenue generation in the
Hospital, through proper inventory and charging of supplies and services. Making sure
 that proper personnel handles monetary transactions in the unit and conduct inventory
management functions that can lessen any possible losses.
 To maximize the potential of the unit in providing excellent services.

III. Statistical Data / Analysis

A. Forecast(Projection for the year 2018)

Note: This projection was made from the previous census in the emergency room.
The allocation for the population has been added with 10% possible increase with 20% for
the month of December where patient peak most.

Classification
Surgery Total Patient per Total Gross
Month
Pediatric Medicine Surgery / Gynecology Census day Revenue
Minor OR
trauma
Jan 172 425 120 16 733 24 439, 800
Feb 140 343 99 9 591 21 354, 600
Mar 94 370 97 21 582 19 349, 200
Apr 161 418 106 13 698 23 418, 800
May 124 414 120 22 680 22 408, 000
Jun 115 416 117 20 668 22 400, 800
July 172 406 105 18 701 23 420, 600
Aug 216 446 106 19 787 26 472, 200
Sep 138 429 110 14 691 25 414, 600
Oct 175 450 140 10 775 25 465, 000
Nov 166 452 107 13 738 25 442, 800
Dec 235 557 162 19 973 31 583, 800
TOTAL 1908 5126 1389 194 8617 286 5, 170, 200

B. Manpower, Operational Hours and Staffing Plantilla.

MANPOWER AVAILABLE NEEDED (FULL OPERATION)

Staff Nurses 13 18
Nursing Aide 5 5
ER Clerk 4 5
Total 23 28

The demand for manpower is currently adequate based on the census projected. The staffing
pattern was initially from 4(am) – 5(pm) – 3(graveyard) to 3(am) – 3(pm) – 3(graveyard)
respectively. In the event that depletion of manpower arises, adjustment of staff from pull out
may be necessary from other area to cope up with the demand.
IV. Proposals

Factors Proposal(s) Planned Initiatives Target

 Review plantilla of  Ensure that the unit is manned 24 hours a  Complete nurse per shift
nurses to maintain day. Nurse-Shift Ratio:
delivery of services.  Availability of ER physician AM – 4
 Availability of nurses and nursing PM – 3
assistants. Night - 3
 Improve the  Conduct routine integrated meetings and  Scheduled monthly meetings
relationship between assembly of all ER personnel attended by the:
Staff Nurses and  Immediate resolution of conflicts and ER Chairperson
MANPOWER Doctors on Duty issues. Chief Nurse
ER Supervisor
ER head
Ancillary heads
ER personnel
 Documentation of every
meetings/ assembly
 Minutes of the meeting
 Follow up of identified issues for
resolution.
 Consistent provision of  Review of needed supplies/ inventory in  Availability of all supplies and
nursing care services the ER based on the services offered/ equipment in the emergency
(e.g., IV insertion, cases commonly or possibly handles. room.
Oxygen Inhalation,  Consultation with the different  Availability and accessibility
MATERIAL Nebulization, Wound departments on the supplies they need in should be observed.
Care) order to provide their services.  Inventory Management
 Strict Inventory Monitoring protocol implemented in the ER in
coordination with the
procurement/ warehouse
departments.
 System to be upgraded on the ER
inventory.
MACHINE  Availability of  Consultation with the different  Available inventory of all ER
emergency medical departments on the equipment needed in equipment.
equipment the ER to aide them in their services;  Logbook/ Documentation of
Review of existing equipment. scheduled preventive
 Routine preventive maintenance to maintenance .
ensure availability of equipment
 Proper documentation
 Increase admission by  Consultative meeting with the different  Result of consultative meeting to
setting a quota/ target department to discuss this initiative. be put into official hospital
admission per  Review ER admission per service/ memorandum.
consultant and department to identify feasible target  Strict monitoring of admissions
residents. admission per department. and implementation of the
METHODS memorandum; Monthly ER
Admissions.
 Implement utilization  Consultative meeting with the different  Result of consultative meeting to
monitoring for department to discuss this initiative. be put into official hospital
diagnostic procedures/  Review utilization of diagnostic services memorandum.
services to all doctors per department/ services/ consultant/  Strict monitoring and
(consultant/ residents) residents. implementation of the
 Identify standard diagnostic test and memorandum.
create diagnostic packages
e.g. CBC, Urinalysis & Chest X-Ray (Basic
Diagnostic Package) etc.

 Proper charging of Use
of Medical Equipment
 Re-orientation of staff on proper charging
of hospital equipment.
 Review of charging process in the ER to
identify loopholes in the process.
 Identify utilization of equipment vs
monthly census/ cases to identify rate of
mischarged items.
 Assign a personnel to monitor equipment
use charging.
 Strict monitoring and
implementation.
 Monthly utilization report of ER
equipment.
 Activate coordination with
warehouse department and
cashiering section.
  Review and Improve  Review the current workflow in the ER
the Emergency Room and identify the following:
Workflow a. Turnaround time of diagnostic
examinations
b. Time and motion of ER triaging,
Patient encounter with a ER resident/
consultant/ admission/ diagnostic
requisition etc.
 Review patient satisfaction survey results
in the ER.
 ULTIMATE GOAL: Minimize waiting time;
Increase patient satisfaction
 Strict monitoring and  Review monthly expense vs revenue
budgeting of  Identify all expense incurred by the
departmental expenses department.
 Involve staff in minimizing unnecessary
MONEY expenses and in the rational use of
resources (Re-orientation if necessary)
 Minimize overtime and other manpower
time wastage.
 Create a monthly target: EXPENSE VS
REVENUE
 Appropriate charging of  Re-orientation of staff on proper charging
medical supplies of hospital supplies
 Review of charging process in the ER to
identify loopholes in the process.
 Identify consumption rate of supplies vs
monthly census/ cases to identify rate of
mischarged items.
 Assign a personnel to monitor supplies
use charging.
 Implement strict  Re-orientation of staff on inventory
inventory management management in coordination with the
warehouse section.
 Turnaround time result of
diagnostic services to be
determined.
 Time and Motion in ER to be
utilized.
 Implement/ formulate NURSING
AUDIT in the ER.
 Results to be discussed with the
management to identify areas for
improvement and to be used to
revise/ the existing workflow.
 Strict monitoring and
implementation.
 Monthly report of ER unit revenue
based on the logbooks vs financial
statement provided by the
finance.
 Activate coordination with finance
department.
 Strict monitoring and
implementation.
 Monthly utilization report of ER
supplies.
 Activate coordination with
warehouse department and
cashiering section.
 Strict monitoring and
implementation.
 Monthly utilization report of ER
  Train ER clerks on proper warehousing/ supplies.
inventory management.  Activate coordination with
 Create a visible inventory system in the warehouse department.
ER in the form of bin cards, log books, etc.
that should be routinely monitored.
 REQUISITION OF SUPPLIES TO BE
SCRUTINIZED/ REVIEWED AND SHOULD
BE CHECKED BY DEPARTMENT HEAD AND
THE WAREHOUSE SECTION HEAD. This is
to avoid unnecessary requisitions.
 Minimizing Expenses  Conduct a monthly inventory to monitor  Strict monitoring and
stocks and supplies within the unit. implementation.
 Limit additional manpower for overtime
especially during holiday seasons.
 Review and limit some non-medial
appliances regarding proper usage to
save electricity.
 Medical supplies other than the available
stocks from the E – cart may be
requested to the pharmacy especially for
non – urgent patient so that monitoring
of supplies may also be monitored.
 Revenue Reports  Delegation of each task of the team  Strict monitoring and
member to submit monthly report of the implementation.
following
1. Departmental expenses
2. Stocks requisition
3. Revenue
 In line with this, yearly budgeting must be
strictly made for the allocation of capital
expenses and revenue may be monitored.