Level 1 Trauma Center Struggles with Throughput
Background
An 886 bed tertiary care center located in the Midwest was struggling with emergency department efficiency and hospital leadership was concerned that the patients were becoming more dissatisfied. This emergency department is the receiving hospital servicing 35 counties and a population of over one million. The trauma center has nearly 90,000 annual visits. The 35 bed Emergency Department and 10 bed fast track area was less than 5 years old, yet the team felt concerned with their ability to meet the growing needs of the surrounding communities. Diversion and walk outs were rising and patient satisfaction was falling.
Assessment
To understand the organization's concerns, an in-depth assessment of the department was performed. Interviews with staff members, administrators and other departments that interface with the ED were held. The assessment team completed direct observation of patient flow processes and reviewed data related to these processes.
Approach
Feedback from staff surveys and Blue Jay Consulting's assessment team provided the impetus for the formation of several project "work teams". The teams were chaired by staff members and facilitated by the on-site consultant. The work teams focused on specific areas that were identified as priorities. There was an oversight team to coordinate all the work groups. Communication via bulletin boards, e-mail, daily huddles and staff meetings was imperative.
Implementation
Work teams were focused on implementing the following processes:
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5-Level Triage |
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Immediate bedding |
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Standing order/protocols |
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Zones versus room assignments |
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"Greeter" triage role for rapid ESI assessment |
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RN flow facilitator to assign beds in the department |
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Revision of RN staffing matrix based on patient demands |
Results
Because of the changes, the department saw a marked improvement in patient satisfaction scores, and a lower left before treatment rate despite an increase in volume of 20% during the 6-month implementation period. The increase in revenue generated from the decreased walk out rate and the subsequent increase in admissions was over $2 million annually. Additionally, the customer service scores went from the 51 percentile to the 83 percentile.
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