State of Emergency

Molly Rowe, for HealthLeaders Media, January 18, 2008

ABC News ran a special feature last week following a day-in-the-life in the emergency department at Parkland Hospital in Dallas. Titled "24 Harrowing Hours Inside the ER", the segment shows a situation all too common in America's emergency departments: ED misuse, wait times upwards of 10 hours, and unhappy staff.

There's no denying that the ED is a problem area in most hospitals. Almost every major Joint Commission change of the past few years--medication reconciliation, handoffs, critical test results reporting--has gotten hung up in the emergency department, and almost every person I talk to, no matter how advanced the hospital, has problems getting his ED on board and in compliance.

In a lot of hospitals, the ED is the problem child no one talks about. CEOs boast about their new Women's Health Center and low turnover but they quietly dismiss their ED's "left without being seen" rate or dismal patient satisfaction scores. An experienced ED manager once told me that he's surprised how many CEOs discount the ED as a loss. CEOs who do regular hospital walk-throughs often skip their EDs, and employee appreciation events don't include ED staff. When it comes to the emergency department, have CEOs just thrown in the towel?

Not all of them. In this month's HealthLeaders magazine cover story, I write about three hospitals that have overcome their ED angst. Through staff changes, reorganization of existing space, creative scheduling, and a focus on customer service, they've caused ED turnarounds without building multi-million-dollar facilities.

CEOs at these organizations would be proud to see their EDs featured on the nightly news, but this wasn't always the case.

Two years ago, North Mississippi Medical Center's ED was well-known in the community for all the wrong reasons: 12-hour waits, angry patients, and apathetic staff. NMMC President Chuck Stokes and his board chair took out a full page ad in the local Sunday paper advertising the ED's problems. "The ad said, 'We realize that we've got problems in our ED; here's what we're going to do to fix them, to improve our turnaround times, our community relationship. We'll give you a follow-up in six months," Stokes told me. Six months later, another full page ad described the ED's improvements and what NMMC had planned for the future.

Stokes and his executive team made a leadership commitment to change. And they did. Today, NMMC's ED volume is up 14 percent since 2006, and its elopement rate is down. Patients are happy, staff is friendly, and the waiting area is virtually empty.

The organizations in my story vary widely (a large hospital in North Mississippi, a six-hospital system in Tennessee, and a tiny community hospital in Ohio) but the leaders share a common philosophy: If you believe your ED can get better--and if you hold people (including leadership) accountable--you'll see improvements.

Accountability means establishing metrics that are tracked and acted upon. It means walking through your ED and learning how it works, and it means thanking staff when things go right (something that is often neglected in the ED).

The leaders in my story admit that turning an ED around isn't easy, but they say it's worth it. "The ED is the front door to your hospital. You can't afford not to have it work right. If the leader continues to see the ED as a financial drain on their hospital, they're not seeing the bigger picture," Stokes told me.

With an estimated 60 percent of all hospital admissions coming through the ED, this problem child is more important to the family than you may think.

Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at
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