Emergency Services Case Study

Business case Emergency Department

  • A 70 Bed Community Hospital desired to take Emergency Services Patient satisfaction from 88% to 100% in a short period of time.
  • This would eliminate patients leaving ED prior to being seen by a provider (LWBS).

Initial Condition

  • Inefficient Processes in ED and lengthy turnaround times (TAT) from ancillary departments like LAB and Radiology were causing delays in patient care.
  • Processes in Registration were causing frequent loss in up front collections of co-payments and possible EMTALA violations.
  • Layout of materials, storage, Omni cells and patient registration areas caused extra steps to be taken by staff to gather and disseminate medications and supplies to patients.
  • Patient wait times of 18 minutes before care began for certain patient populations had a direct correlation with the patient satisfaction scores (88th percentile).
  • Another obvious result of these problems is the amount of patients that were leaving without receiving treatment (LWBS 2%).

Target ConditionFootprinting Example

  • Recue Patient LOS to less than 150 minutes for ESI 1-5 Pt.
  • Reduce LOS to less than 100 minutes for ESI 4-5 Pt.
  • Improve Pt. Satisfactions scores to 100%

Planned Activities / Intervention

  • Implemented “Fast Track” process to sort patients based on a severity scale (ESI1-5), this allowed us to expedite patients requiring fewer resources through the department. (ESI patients 4-5)
  • Developed process to immediately room patients upon arrival to the department along with bedside registration to reduce waiting to see care provider
  • Redesigned area layout to centralize supplies and medications to reduce walking and searching for needed items to provide patient care
  • Develop standardized processes to improve outcomes and TAT’s of ancillary departments on tests such as EKG’s, Cardiac Injury Panel’s (CIP) and CT’s
  • Developed standardized methods and scripting for collections along with a redesigned area to facilitate flow of patients past collection area upon exit of the ED

Achieved MetricsEmergency Department Working Center

  • Initial Patient waiting reduced from 15 min. to 3 min. (improved 500%)
  • Arrival to MD time reduced from 42 min. to 28 min. (improved 33%)
  • Average LOS, ESI 1-5 PT reduced form 168 min to 125 Minutes (improved 26%)
  • Average LOS, ESI 4-5Pt reduced from 152 min. to 90 Minutes (improved 415)