ED Throughput - Brazosport Regional Health Systems
The Case: Brazosport Regional Health System, Lake Jackson, TX
175-bed Brazosport Regional Health System’s Emergency Department was facing many of the challenges being faced by EDs across the nation: growing numbers of uninsured, underinsured and/or undocumented patients; increasing patient acuity levels; high number of hours on EMS diversion; and a shortage of
inpatient psychiatric treatment facilities driving more patients to the ED.
In addition, the ED was struggling with:
- Patient throughput issues that created ED backflow;
- Poor physical plant design; and
- Support staff shortages.
“Something had to be done quickly to turn our ED around, as it is our primary point of patient entry – approximately 90 percent of admissions originate in the ED,” said Candice Fonke, CNO at Brazosport Regional Health System. “Our low patient satisfaction scores and high number of patients who left without being seen by an MD or mid-level provider were negatively impacting quality of care and contributing to significant lost net revenues.
“When QHR consultants came in, they were quickly able to identify barriers to efficient patient flow, as well as processes that had to be addressed to achieve significant and sustainable improvement,” she added.
Q Solutions
Address the impact of hospital-wide patient flow challenges on the ED.
- Develop and implement key access strategies;
- Create a written algorithm that outlines all efforts to manage admissions in other parts of the hospital before shifting to diversion status or holding patients in the ED;
- Hold unit directors and charge nurses accountable for staffing levels in their areas; and
- Establish a department that is solely responsible for patient access and placement of patients in the hospital.
Optimize the physical plant to improve ED throughput.
- Install a cardiac monitoring system in all patient care rooms;
- Purchase transport monitors for use in observation bay; and
- Develop and implement a 5 Zone Care Delivery model to improve patient access and customer service, and increase physician and staff satisfaction.
Shift to the 5-level ESI triage system to support improved safety, quality, accuracy and consistency in the triage process.
Assure appropriate staffing and patient assignment of Fast Track.
- Add eight hours of tech coverage during peak hours to provide support between triage and Fast Track areas; and
- Create a sub-waiting area between triage and Fast Track to facilitate improved throughput and maximize room turnover.
Develop a staffing plan to assure the right resources are in the right place at the right time to support customer satisfaction and reduce percentage of left without being treated.
- Incorporate 6, 8, 10 and 12-hour shifts into staffing model to support flexes in volumes;
- Concentrate on hiring part-time and PRN positions to increase scheduling flexibility; and
- Develop a staffing matrix based upon the 5-zone care delivery model
Empower the ED nursing team.
- Ensure nursing leadership has regular access to operational data, including ALOS, LWOBT, customer service scores, etc.;
- Encourage ongoing education through collaborations with EMS, support of pursuit of specialty certifications, and creation of an education committee; and
- Recruit and retain experienced RNs with strong compensation packages and flexible scheduling.
The Results
Between June and December 2010, BRHS’ ED experienced the following improvements:
- Wait time for inpatient bed: decreased from an average of 2.5 hours to 30 minutes;
- Left-without-being-seen by an MD or midlevel provider: decreased from 12.5 to 3.43 percent;
- ED turnaround time: decreased from 3.35 to 2.99 hours;
- Patient satisfaction: increased from 18 to 40 percent and
- Hours spent on ambulance diversion: decreased from 57 (for one month) to less than 10.
QHR enabled us to implement a significant turn-around of our Emergency Department, which we were unable to accomplish alone,” said Fonke. “Thanks to QHR, we have seen major improvements in patient flow, patient safety, customer satisfaction and staff morale.”
