Community hospital
struggles with ED
throughput and
performance improvement

A 460-bed hospital with a history of unsustainable success in process improvement was not meeting its emergency department (ED) expected performance and wait time targets. The 48,000 annual visit ED had previously tried to address the issues by developing a fast track program, followed by a model where a mid-level provider would initiate workups on select low acuity patients. Neither initiative took hold nor had the impact on flow that the organization sought. They contacted Philips Blue Jay Consulting to help them improve their ED performance.

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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 related data. The two major areas of opportunity identified were the revision of front-end processes and the realignment of staffing resources away from a serial model of care.

Approach

Information obtained from ED staff and hospital leadership along with the Philips Blue Jay Consulting assessment team provided the foundation for the project “work teams”. Each of the teams had designated co-leaders (a physician and a nurse) and was facilitated by the onsite consultants.

Team membership came from all of the disciplines that work in the ED. In this multi-disciplinary model for performance improvement, thirty-seven ED staff members participated in the work to discuss, design and implement solutions to positively impact patient care and flow. In addition the team members and the department leaders kept their colleagues informed about the work of the teams and brought staff input back to the teams.

Implementation

During the 6 month project the work teams focused on the design and implementation of the following solutions:

• Greeting by an RN on arrival
• Rapid triage with streamlined documentation requirements

• Immediate bedding whenever a treatment space was available

• Redefined components of quick registration

• Geographically assigned care teams composed of providers, nurses and techs

• Providers and nurses seeing patients together

Results

With the changes made in patient care and flow, the department realized significant improvement in arrival to triage (68%) and arrival to room (77%) as compared to their baseline.

Additionally, there was a 51% decrease in the number of patients wholeft the ED without treatment. The decrease in ED walk outs generated additional revenue of over $2 million annually for the organization. And finally, at the end of the project the department had a foundation for collaborative multidisciplinary performance improvement with proven success.

Results include the below:

68% improvement in arrival to triage
77% improvement in arrival to room
51% decrease in ED walk-outs without treatment

Meet our team

William R. Welsh, MSN, MBA, RN
Principal, Philips Blue Jay Consulting

Bill is a dynamic and talented nurse leader with over 30 years of experience in emergency care and patient flow. In his most recent roles, facilitating performance improvement and in interim leadership positions, he has successfully developed client relationships and effectively mentored other nurse leaders to improve operations within their departments. Bill excels at assessing client operations in order to identify opportunities for improved patient flow and service.

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