Good Samaritan Hospital: Emergency Department Optimization

By Nicole Dunham RN, BSN, CEN

On March 23, 2010, President Obama signed the Affordable Care Act, also known as “Obamacare.” It was enacted with goal to reduce health care costs for individuals and the government by increasing quality and affordability. With changes in reimbursement, we are being forced to look closer at all hospital operations. To that end, this also requires us to “optimize” utilization of emergency department/services. Despite having a group of highly-trained physicians and nurses working in the emergency department (ED) at Good Samaritan, there is much room for process improvement. Current issues include long ED wait times, and long lengths of stay (LOS), resulting in sub-par patient experience.

Patient experience is very important, since it is a factor that influences patient loyalty. Furthermore, patient experience is included within the value-based purchasing program embedded into the Affordable Care Act, which affects ED reimbursement. Proper reimbursement is vital to continuing to fund the facilities and the thousands of employees who provide excellent patient care to our community. Health care is no longer a commodity--it is a right. Decreasing wait times and LOS will positively improve patient experience, efficiency, and employee satisfaction.

During the week of May 12-15, 2014, the Good Samaritan ED held a Six Sigma Lean event, based on the principles of W. Edwards Demming. The methodology allowed the team to identify ways to improve workflow, eliminate waste, and deliver valuable care. The ED/Lean Vision statement and goals is to enhance our readiness to respond to the health care needs of our community by using the lean transformation process. We aim to increase satisfaction of our patients, employees, and medical staff, and to create an environment that will attract and retain top talent at Good Samaritan Hospital. We will achieved our vision by using the lean transformation process to substantially reduce ED LOS for both admitted and discharged patients; door- to-provider times; admit decision time to ED departure time for admitted patients; and the percentage of patients who leave without obtaining treatment (LWOTs). Staff from the ED including RNs, techs, physicians, residents, HUCS, patient access services representatives, as well as physician assistants; inpatient nursing staff; respiratory therapy professionals; medical imaging staff(including radiology, CT, and ultrasound) staff; laboratory personnel; environmental services staff; administrative officers; referral management staff; transport employees; materials management workers; the ASAP Epic team; hospitalists; and a facilitator from team health (the ED physician group) participated in the Lean event. The group looked at every aspect of the patient experience from arrival, to emergency care, to discharge/admission, and all processes in between. They conducted a timed study for each process, in order to find opportunities in current work flow. The event went on for three-and-a-half days, and the assessment touched every part of the hospital.

We noticed exciting and positive change immediately after the ED Lean event. The first pilot program, initiated June 9, engaged the transport team to participate in moving admitted patients to inpatient beds, and implemented a new ED bed-parking and turn-around process. The heart and vascular 1 (HVH1) inpatient unit is piloting a new nurse report handoff process that began June 30. On July 2, the ED initiated huddles every two hours with the ED team leader and physicians; re-launched the split flow model for express care; changed the processes for urine collection at triage; improved ED RN to ED RN bedside handoff; and implemented a variety of communication tools. We are currently reviewing supply management processes, as well as others.

The process is very exciting. It will also require that everyone keep an open mind, embrace change, and provide ongoing feedback to ensure a successful journey. Patient flow can only be as fast as its slowest constraint. As we innovate, we will also be taking risks, and not every new idea will be a success. We look forward to sharing the results of our work in the next edition of the Premier Nursing News.

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Source: Nicole Dunham RN, BSN, CEN

Content Updated: March 25, 2015

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