ED Patient Throughput
Leesburg Regional Medical Center, Leesburg, FL
The Challenges
Bottlenecks in the emergency department at Leesburg Regional Medical Center were limiting its ability to serve patients; they were also limiting volumes and revenue.
- Average ED length of stay was 284 minutes: triple that of top performers (91), and 80 percent higher than average (158)
- Patient satisfaction with ED service was low (in Press Ganey’s 27th percentile)
- 11 percent of patients were leaving without being seen
- The ED was on diversion almost six percent of the time; this was costly: 27 percent of admissions came through the ED
Q Solutions
Working closely with Leesburg’s capable leadership, QHR took a hospital-wide approach.
“The biggest shift was our mindset,” comments Phyllis Baum, the hospital’s VP of clinical services and chief nursing officer. “The ED issue became an organization issue. Everyone owned it. Everyone was involved.”
Data driven in her management style, Baum used the tools QHR developed to help all departments determine how to remove barriers to throughput. “They gave us a daily snapshot of bed availability; now we forecast rather than react.”
With solid information, the team was ready to implement QHR’s most important recommendation: a realignment in how the organization assigns beds.
Creating a new position with responsibility for bed placement, they built a patient placement center around it. “The PPC puts resources where they’re needed,” Phyllis explains. “A transporter is assigned to the ED during certain times; an admit nurse takes pressure off the nurses upstairs by doing admission assessments… or by facilitating discharges.”
Changing the way people work can further stress an already stressed-out team, creating resistance. Phyllis was glad for back up. “QHR was on-site, with strong clinical expertise. That credibility – and the fact that they met with line staff rather than just managers – helped us get buy-in for the changes. Soon, progress created its own momentum.”
The Outcome
- Diversion dropped from 5.85 to 2.33 percent over the engagement and to zero the next year; the hospital received a letter of thanks from the county EMS
- ED wait times were cut in half
- LWOBS fell from 11 to 4 percent during the engagement, and later to 1.4 percent (benchmark is 1.9 percent)
- Patient satisfaction reached the 93rd percentile
- ED volumes rose from 3,185 and later to 3,543, an increase of 11 percent
- Admissions from the ED grew from 805 to 1,173, an increase of 46 percent
- Overall hospital operating income rose 125 percent
"QHR was on-site with strong clinical expertise. That credibility helped us get buy-in for the changes."
