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THROUGHPUT: How to improve patient care processes

Mercy St. Vincent Medical Center (Toledo, OH, 445 beds) was able to cut costs by over $70 million and decrease average length of stay by nearly one full day by undertaking an organization-wide operations improvement initiative called “Patients First: Journey to Zero.”  The area in which the largest savings were realized was in the category of productivity of non-nursing areas.  The initiative began with an analysis of the inpatient stay and an identification of eight milestones of care.  While individual departments were found to be performing well, there was room for improvement in coordination of care between functional areas (in the “white space”).

Source: Platzke, S.M., and Andrabi, I.A.  Focusing on white space to improve patient throughput.  HFM. Healthcare Financial Management;66(8):102-106, 108, Aug. 2012.  Click here for the publisher’s website: http://www.hfma.org/Templates/InteriorMaster.aspx?id=33695  Posted by AHA Resource Center, (312) 422.2050, rc@aha.org

Busy ED flows around patients

Cambridge Health Alliance – a three-hospital system headquartered in Cambridge, MA – has re-engineered its emergency department services using a patient-centered care model that has led to increased efficiency, happier staff, and higher patient satisfaction scores.

The new model includes:

  • Patient partners – non-clinical staff who greet incoming patients, gather necessary information (name, date of birth or Social Security number, nature of emergency), and then take them immediately to either an assessment room or into the main ED for immediate care
  • Multiple triage nurses – instead of one nurse doing all triage, there are now multiple nurses who perform this function, as well as providing nursing assessments and initiation of care for those patients with less emergent conditions
  • Registration on the go – registration staff come to the patient’s room  and complete the registration process while the patient is being assessed and/or treated

The results speak for themselves:

  • For rapid assessment patients, the average length of stay has dropped from three hours to slightly more than one hour
  • 97 percent of patients are in a room within 5 minutes of entering the ED
  • 90 percent of patients are seen by a provider within 14 minutes of entering the ED

Dr. Sayah, ED director sums up his department’s paradigm shift: “The new culture is that the patient is in the room, and we are going to move around that patient.  The nurse will come in, the doctor will come in, the registration will come in, whereas before the patient was moving around us.”

Source: System-wide flow initiative slashes patient wait times in the ED, boosts volume by 25%.  ED Management.  24(6):61-64, June 2012.  Available for purchase from publisher’s website at http://www.newslettersonline.com/user/user.fas/s=6/fp=3/tp=3?T=open_article,50062141&P=article

Volume, Flow, and Safety Issues in the ED

Results of a new HealthLeaders Media survey provide a glimpse of issues and trends for the hospital emergency department.

Patient flow is cited as the greatest strategic challenge related to the ED. However, three-quarters of survey respondants reported average wait times for ED patients to see a provider were an hour or less. The average ED wait for an inpatient bed was up to 3 hours for 69% of the EDs represented, with 27% having bed wait times in the 4-6 hour range. Just under half of those surveyed indicated their EDs were overcrowded.

Nearly all of those surveyed reported efforts underway to improve ED efficiency, and the most effective techniques given are ranked.

When asked about the ED’s contribution margin to the bottom line of its hospital, 37% didn’t know and another 37% said it fell in the 1-10% range.

Source: Cantlupe J. Volume, flow, and safety issues in the ED. HealthLeaders Media Intelligence Report, May 2012.http://content.hcpro.com/pdf/content/279647.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

“15-minute” emergency department guarantee

A number of providers are experimenting with “15 minutes or free” offers for urgent care visits.   Examples include:  Emerus Emergency Hospitals, freestanding emergency hospitals in Texas, which ran a promotion at the end of 2010 guaranteeing patients would be seen by a physician within 15 minutes of completing their paperwork — or there would be no charge for the visit.   At Northern Nevada Medical Center (Sparks, NV), the guarantee is to be seen by a nurse within 15 minutes of arrival.  Emory-Adventist Hospital (Smyrna, GA) has a twist on this idea that allows the hospital to schedule the arrival of urgent care patients by offering the guarantee to those who enter the system by first registering for an appointment on the hospital’s website.  There is a small charge for this “place holder” service, but then a guarantee of being seen quickly upon arrival at the facility. 

Source: Emergency care in ’15 minutes or it’s free.’  Houston Business Journal, Nov. 5, 2010.  Please also click on the underlined hospital names above to link to more information about their 15-minute offers.