Hospital's 'No-Wait' Culture Slashes Costs

Medical equipment tagging is saving a New York hospital hundreds of thousands of dollars a year. Its savings on patient tagging will be known soon. Next? The COO is considering employee tagging, to monitor hand washing and reduce infection rates.

Paul Milton sees his chief responsibility as chief operating officer of Ellis Medicine as trying to make the hospital and health system more efficient. It was not always that way, says Milton of his five-year tenure at the 438-bed community and teaching hospital system in New York's Capital region near Albany.

It's not hard to pinpoint when he shifted his attentions to efficiency.

It was 2008, when the health system merged two community hospitals driving heavy volume to the remaining facility's emergency department and general patient population.

"So we really had to get on our game because of the volume increase," he says.

Good thing, because that crisis provided the motivation to tackle bigger things later. Moreover, he says, Ellis caregivers had to get on their game because efficiency—in patient care, in wait times, in patient satisfaction—is an increasingly critical ingredient in the recipe for success, no matter where organizations are on the journey of replacing a volume strategy with a value one.

"We needed to do as good a job as possible to make sure the patient flow and length of stay and discharge worked really well," he says. Because Ellis Hospital had to take over ED services from the merged hospital that closed to inpatient care, volume increased dramatically—17 beds were added over the course of 90 days to the Ellis Hospital ED. Patient flow was the chief challenge in integrating the two into one.

"With everything we were doing in trying to improve flow, I was thinking about how we could make sure the nurses' time is best spent with patients and not running around looking for an IV pump," he says, noting the chief time-waster his team identified.

Thanks to a local partnership with GE, which has a large presence in nearby Schenectady, he got an early demonstration of how RFID tagging could work to reduce nurses' time spent locating equipment and decided installing it was the right move operationally.

The tagging easily identified the location and status of each of the 500 IV pumps the hospital was trying to track—to that point unsuccessfully. An incidental discovery was that the hospital was oversupplied with the devices.

"Once we redid the workflow and we tagged all the pumps, instead of needing 500, I [realized we] only needed about 340," says Milton. "That value was roughly around $400,000 a year. Multiply that by three years and that's where you get $1.1 million. We used those savings to purchase the technology."

Milton says he works most frequently with the operations team in avoiding backups from the ED, which can mean patients waiting for a bed, a big no-no given the culture leaders at Ellis are trying to integrate.

"The focus on overall flow includes a lot of different departments: Transportation, the whole registration department, the case managers," he says. "And increasingly, [CMS's new] two-midnight rule is getting a lot of attention."

See Also: Two-Midnight Rule Creates Financial Hurdles, Perverse Incentives

With tracking technology already in place, Milton says adding patient tracking tags was as simple as assigning them to patient. That way, the staff can further streamline patient flow from the ER.

"My thinking all along was to start small and build on it, so after success with IV pumps, our next wave was tagging patients when they come into the ER," he says.

RFID tags on patients track them from the time they register at the ED to the time of discharge either from the ED or from an inpatient room. Implemented only three months ago, Milton says it's too early for definitive results on wait times, but he will soon have more data he can review on those metrics.

"We're getting really good data for patients who, for example, go down for X-ray, and the system does some automatic prompts that should help the staff," he says. "The staff are pleased, particularly at the end, with discharge. They cut off the wristband and throw it into the RFID box, which sends environmental services a message saying that room's ready to be cleaned. It's definitely gotten us more efficient on turning over the room."

It's all part of what Milton says is a no-wait culture organization-wide, primarily focused on improving the patient experience.

"Whether with value-based purchasing or specifically with HCAHPs, we look at wait times from an ER patient from the time when they're registered to when they see the physician, to when the decision was made to admit, to when the patient gets to the room. Those stats we look at daily," he says.

And they're not finished with the potential of RFID tagging.

"The GE guys are on me to tag employees," he says. That initiative has to do with hand hygiene and infection.

"I'm willing to be an early adopter with minimal financial risk to test out this technology, which records whether caregivers go into patient rooms without using the sanitizing dispenser," says Milton. "I'm going to know if you're doing that. If that reduces infection rates, we'll save a lot financially and also the patient will be safer."