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ED throughput: Reducing walk-out rate by 85.3% at St. Mary Medical Center

St. Mary's

Improving ED workflow and performance at a 44-treatment emergency department

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, in early 2015.

 

The 44-treatment emergency department was receiving approximately 82,800 visits annually and was struggling with a constrained physical plant space, recurring gaps in ED nursing leadership, prolonged ED lengths of stay and high left without being seen rates.*

Results

When St. Mary Medical Center began its engagement with Philips Blue Jay Consulting, ESI level-3 patients often found themselves in the ED waiting room, not knowing what the plan was for their care, with no ownership from staff, for a stay that could seem like an eternity. This project helped develop and implement a process that resulted in:
info line trending upward
growth in average daily census
LWBS infographic
reduction in LWBS
LWBS infographic
reduction in arrival-to-provider time
34.3% reduction
reduction in discharge patient LOS*

Our assessment methodology

 
  • Review of data collected for patient volume, arrival patterns, staffing patterns, ESI level distribution, ED billing visit level distribution, disposition breakdown and length of stay

  • Interviews with administrators, departmental leaders, and staff, addressing topics such as intake, triage, processes and education

  • Observation of patient flow, departmental processes and communication

Our recommendations

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Revise front-end processes to include the intake and triage processes
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Re-educate staff on the ESI 5-level triage system, to include inter-rater reliability and competency validation
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Restructure leadership and clarify roles of each member of the ED team, increasing accountability for standards of practice and quality of patient care 
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Examine utilization of existing space to optimize workflow 
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Implement standard work processes to address the frequent capacity issues in the ED 
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Create and agree to a shared vision and mission for the ED leadership team 
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*Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.