Enhancing ED performance through interim healthcare leadership and process optimization

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The Emergency Department (ED) of a 350-bed community hospital providing complex and specialty care for a city of nearly 77,000 people was struggling with a lengthy triage process, a lack of urgency to move patients, and a poor community perception.

They asked Philips Blue Jay Consulting to provide interim healthcare leadership and work with them on an intensive, staff-led process optimization program. During a six-month engagement, Philips worked with the ED staff and leadership teams to implement process changes which would improve hospital performance.

Changes initiatives resulted in significant performance improvement:

Arrival to triage times were reduced from 10 minutes to 2 minutes, an 80% improvement
Arrival to room times were reduced from 40 minutes to 11 minutes, a 73% improvement
The left without being seen (LWBS) rate declined from 4.8% to >1%, a 79% improvement
The Press Ganey scores improved dramatically from 4th percentile to 82nd percentile
The reduction in LWBS equated to 1,000+ ED patients representing a $2.8 million increase in revenue

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Our Approach

Although the ED had recently been redesigned, the 32-bed unit was constantly at capacity, forcing the arriving patients to fill the crowded waiting area. Philips Blue Jay Consulting was brought in to facilitate change and manage the department. Two consultants worked side by side with the caregivers for six months.

Assessment

The consultants completed a comprehensive assessment.

The anticipated volume of 155 patients a day was averaging over 170 patients a day and the facility processes were not consistently followed. The community’s perception of the ED was poor but it was the only ED for 45 miles so most patients did not have an alternative.

The assessment identified several areas needing improvement including process standardization, accountability, wait times and walk out rates, and more.

Process improvement

The consultants gathered feedback from the caregivers, asking them to identify specific barriers to providing quality, efficient care to patients. 250+ barriers were identified, prioritized on key areas, and workgroups were formed to address the issues.

The triage team focused on improving the front end processes. This included triage education, customer service for arriving patients, and redesigning the lobby. The throughput team concentrated on realigning the zones of care, addressing the arrival patterns of the patients and staffing to meet the demands.

Results

At the end of the six-month engagement:

Arrival to triage times were reduced from 10 minutes to 2 minutes, an 80% improvement
Arrival to room times were reduced from 40 minutes to 11 minutes, a 73% improvement
The left without being seen (LWBS) rate declined from 4.8% to >1%, a 79% improvement
The Press Ganey scores improved dramatically from 4th percentile to 82nd percentile

The reduction in patients leaving the waiting room without being seen equated to over 1,000 ED patients, representing a $2.8 million increase in revenue for the facility. The enhanced triage process represented improved time to the doctor, thus decreasing risk to patients. The enhanced processes decreased wasted steps and time, improving caregiver and patient satisfaction.

Meet our team

Ricky J. McCraw, MBA, MHA, RN, CEN, FACHE
Principal
Philips Blue Jay Consulting

Rick has over 30 years of emergency, trauma, and physician practice leadership experience. He led a Level 1 trauma center ED and has reduced door to provider times, the decision-to-admit to inpatient bed times, implemented point-of-care testing in the ED, and streamlined nursing workflow and the ED discharge process. Rick is a certified nurse specializing in emergency nursing.

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