Implementing process flow improvements to expedite patient care
When an emergency department’s workflow is inefficient, wait times can increase, care is not always provided in a timely manner, and patient and staff satisfaction may suffer. This was the situation at St. Mary Medical Center (SMMC) in Apple Valley, California.
Philips consultants joined SMMC as Interim ED Manager and Interim ED Director, and led an intensive multidisciplinary performance improvement assessment that included a thorough analysis of data collected for volume, arrival patterns, staffing patterns, ESI level distribution, ED billing visit level distribution, disposition breakdown, and length of stay. The assessment identified several areas that were in need of improvement, and resulted in the following actions:
Revise front-end processes to include the intake and triage processes
Re-educate staff on the ESI 5-level triage system
Restructure leadership and clarify roles of each member of the ED team, increasing accountability for standards of practice and quality of patient care
Examine use of existing space to optimize workflow
Implement standard work processes to address the frequent capacity issues in the ED
Create a shared vision and mission for leadership team
A key component of the PI recommendations was the development of a new process solution termed ‘Middle-Trac’. A derivative of a split-flow process where patients are triaged quickly into parallel care streams, Middle-Trac focuses on patients in the middle (ESI level 3) who do not require immediate treatment. It keeps these patients vertical and moving through the department, not occupying valuable treatment spaces until a disposition decision is made.
Similar to an assembly-line, elements of the Middle-Trac process work cohesively. A triage nurse classifies arriving patients into one of three categories: immediate bed needed, fast track appropriate, and remaining Middle-Trac patient population. A detailed process flow maximizes continuity of care, manages essential resources, and minimizes provider hand-offs
The Philips-SMMC team was successful in implementing process changes that significantly improved door-to-provider times, ED length of stay, and the left without being seen rate for Middle-Trac patients. Two Philips consultants were asked to remain in the interim leadership roles long-term.
As a result of the engagement, SMMC was able to achieve the below results:
4.4% growth in average daily census
34.3% reduction in ED discharge patient length of stay, 361 to 237 minutes
66.2% reduction in arrival-to-provider, 74 to 25 minutes
85.3% reduction in left without being seen (LWBS), 7.5% to 1.1%
* Results from case studies are not predictive of results in other cases. Results in other cases may vary.
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