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How Boosting ED Efficiency Turbo-charges Metrics

Philip Betbeze, for HealthLeaders Media, September 14, 2010
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A backed-up ED doesn't just mean dissatisfied patients.

In cynical circles, it was once thought that hospitals generally didn't do much to address problems in patient throughput in their emergency departments because there were a lot of uninsured in there, and those patients didn't pay very well. But it's more complicated than that. For many, it just wasn't a key priority for other reasons as well—there were bigger matters to manage, such as labor problems, reimbursement issues, and contracting challenges that forced the C-suite to pay attention elsewhere.

But those excuses are long past their freshness date.

Mission Hospital in Asheville, NC, sees more than 100,000 patients annually in its ED. It has recently struggled with backed-up waiting rooms, dissatisfied patients, and unhappy employees. In fact, door-to-doctor times soared to 92 minutes, and patients were leaving without being seen at a rate of 7.2%.

That's one reason Mission conducted a massive overhaul in processes within the department, emphasizing teamwork among the many pieces of the system the patient might touch. The initiative is called Physician Integrated Team Triage.

The other reason is that about two years ago, Mission, which consists of two neighboring campuses, decided to merge the two EDs—both of which had problems with throughput. That meant an overnight gain in volume of about 50%, which only added to the urgency to redesign processes, says Susan Jarvis, RN, the ED's administrative director.

"We wanted to be more efficient whether we consolidated or not, but consolidation gave us a deadline," she says. "We found that if you can move the wait until after patients are seen by the physician, they're a whole lot happier."

"Even with two EDs we had extremely long waiting times," says Jason Hunt, MD, the ED's medical director.


"One improvement came when we created a turbo track to make up for the loss of space. If a patient is a turbo track patient [usually less serious emergencies], they go pretty much immediately back to see a nurse practitioner." That two-bed treatment space includes an NP, a nurse, and a tech. Thanks to the process changes:

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