Improving ED operations and inpatient throughput at Winchester Medical Center

Helping to improve ED processes and patient discharge times

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Winchester Medical Center (WMC), a 445 -bed non-profit regional referral center was having issues with ED crowding, boarding, and critical care diversion which stemmed from hospital-wide throughput. WMC had implemented unsuccessful change management strategies and looked to Philips Blue Jay Consulting for a new approach to improve ED performance and the transition to inpatient care.

 

As part of a two-part engagement, our consultants worked collaboratively with the WMC team to teach, mentor, and guide cultural and operational change for ED performance and then to prioritize and help implement changes for hospital-wide throughput improvement.

 

Due to implemented change initiatives, WMC achieved the following results:

 

  • 39% decrease in left without being seen (LWBS)
  • 84% improvement in arrival-to-triage
  • 23% improvement in bed assignment to patient in bed (ED to acute care transfers)
  • 48% improvement in discharge order to critical care discharge
  • 16%-21% improvement in patient discharges before 11am
  • 477% improvement in patient satisfaction (75th percentile)

 

The staff also reported that they felt empowered and appreciated a culture of increased accountability.

An innovative approach

Focus on ED performance


Our consultants completed a comprehensive ED assessment including data analytics, onsite observations, staff interviews, and more. Inconsistent practices and processes were identified.

 

Opportunities for improvement were prioritized including front-end intake processes, facility layout for improved patient flow, new standard practices, education and competency validation in the use of the Emergency Severity Index (ESI) triage program, and revisions to the charge nurse role to focus on patient throughput.

 

The Philips team helped the WMC team develop, test, and implement ED performance change initiatives over a six-month period.

Patient Satisfaction Graph
Arrival to Triage Graph

Focus on hospital-wide patient throughput

 

As WMC’s ED performance improved, arrival-to-admit and inpatient bed requests/delays began to rise. This triggered an increased urgency to improve the efficiency of all patient throughput processes across the hospital. Educating the staff on the importance of such dedicated efforts and their impact on long-term success was also identified as an urgent next step.

 

The Philips consultants assessed the hospital-wide processes impacting patient throughput and identified several areas for improvement. They helped create and worked with an oversight team, steering committee, and six multi-disciplinary, employee-led work-groups. Focus was on patient touch points that effected length of stay (LOS) including patient access, patient placement, patient care, patient support, patient discharge, and a performance scorecard.

 

This was followed by a six-month execution phase in which they developed, tested, and implemented the solutions.

Bed Assigned Graph
Discharge order to critical Graph

Results

As part of the first engagement, the Philips team helped Winchester Medical Center develop, test, and implement ED performance change initiatives over a six-month period. As a result of the changes, WMC achieved the following improvements. The staff also reported that they felt empowered and appreciated a culture of increased accountability.

 

  • 39% decrease in left without being seen (LWBS)
  • 84% improvement in arrival-to-triage
  • 55% improvement in arrival-to-room
  • 23% improvement in arrival-to-provider
  • 477% improvement in patient satisfaction (75th percentile)

 

For the second engagement, our consultants helped WMC implement changes to support increased patient throughput. The staff has a strong understanding of the importance of throughput processes and their impact on the patient experience. The journey to increased patient throughput has just begun but early results include:

 

  • 23% improvement in bed assignment to patient in bed (ED to acute care transfers)
  • 48% improvement in discharge order to critical care discharge
  • 16%-21% improvement in patient discharges before 11am in medical/surgical, step down, and critical care units

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* Results from case studies are not predictive of results in other cases. Results in other cases may vary