ED Throughput
The Case: Opelousas General Hospital, Opelousas, LA
Marking its 50th anniversary with a $68 million expansion, Opelousas General Hospital had proven its commitment to its community. A strong reputation for quality and expanding capabilities was widening its market, attracting patients from further and further away. “We’re frequently full,” explains CFO Brian Kirk. “There’s not a bed to spare.” The ED team struggled to keep up:
- ED wait times averaged two hours; length of stay in the ED exceeded three-and-ahalf hours
- 6% of patients were leaving without being seen (LWBS)
- 100% occupancy put the ED on diversion 50% of the time
- Length of stay was high for observation patients
- The hospital was losing admissions and related revenues
Q Solutions
QHR’s clinical consultant quickly recognized that two related issues limited the ED’s efficiency: length of stay and patient placement.
She developed a coordinated approach, starting with educating case managers and physicians on the financial impact of misuse of observation status and excessive length of stay. Analyzing their own patient data, she helped them identify outliers and better understand admission criteria.
Soon, many patients who previously would have been held for observation were admitted or discharged.
To expedite ED service, QHR’s expert redesigned workflows and set targets for door-to-doctor and other key timeframes. Tracking progress with dashboards, she kept the team informed and motivated.
Looking beyond the ED to address length of stay, she formed a throughput team, including all patient-care department directors. Holding concise daily meetings, they focused on disposition of patients who no longer met acute care criteria. Prepping physicians the day before discharge kept the process proactive.
“She worked well with our people,” comments Kirk. “From housekeeping to medical and clinical staffs to administration, she found our best opportunities and got us focused.” He is pleased with the results. “We were having to send patients to our competitor because too many beds were filled with observation patients,” he admits. “Now, using our resources more appropriately, we’re able to serve more patients – for better reimbursement.”
The Outcome
Within six months:
- ED wait times fell by 16%; LWBS is down 21%
- ED length of stay declined by 13% and boarding hours dropped by 49%
- Diversions were eliminated; ED volumes climbed by 2.6%
- 46% of observation patients were converted to admissions
- Increased ED and inpatient volumes added an annualized $1.2 million in revenue
“QHR’s consultant was thorough, proactive and team oriented in her approach. Our physicians were impressed. Personally, I’m thrilled. Not only do patients have a better experience in our ED, but the additional revenue will help us fund improvements. ”
