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Why Is The ED Such A Pain?

Molly Rowe, for HealthLeaders magazine, January 15, 2008
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NMMC-Tupelo removed the patient visitation signs and installed telephones in every patient room. Families became more involved in the discharge process and follow-up care. NMMC-Tupelo also changed its registration process to one that focused on the patient's health rather than the wallet. Previously, when a patient presented to the ED, one of the first questions asked was, "Do you have insurance?" But not anymore. "We wanted to make sure the public knew that when they came to the ED, they came to a setting where we care about them first, so we don't ask any insurance information until after the medical screening is done," Della-Calce says.

Customers...remember them?

Culture and customer service may go hand in hand, but customer service's role in an ED's success or failure makes it a key ED principle on its own.

All employees in every department of 25-staffed-bed Allen Community Hospital undergo mandatory customer service training, part of what Susan Bowers, vice president of patient services, calls a "maniacal commitment to patient satisfaction." This training is key to the success of the Oberlin, OH-based hospital's "ED guarantee"

Wellmont Health System in Kingsport, TN, shares Allen Community's attention to customer service--but only after learning some hard lessons. When Richard Salluzzo, MD, became CEO of the then six-hospital system in 2004, visitors to any of his four EDs spent most of their time in the waiting room. The ED's reputation went from bad to worse after the publisher of a local newspaper called 911 from Wellmont's ED when his daughter, in severe pain, waited more than four hours to be seen for a kidney stone.

As a CEO and working ED physician, Salluzzo knew firsthand the process challenges of the emergency department. He also knew that a million-dollar renovation wouldn't solve those challenges. "Sometimes size is made up as an excuse. A new building helps, but it's not a panacea. If you have bad process in an old ED, you're going to have bad process and you're going to get bad results in a new ED," says Salluzzo.

Salluzzo and his ED leaders went about making dozens of process changes--starting in the parking lot. Visitors to Wellmont's ED are greeted with wheelchairs to transport them to the front door. The greeters also ensure that the area outside is clean and free of trash or cigarette butts.

Once they're greeted, patients are met at the ED's front desk by a triage nurse (two Wellmont hospitals have a minimum of two triage nurses and two paramedics on shift at all times). Each triage nurse is coupled with a registration clerk to immediately capture information on the patient as they're talking to the triage nurse. With this process, Wellmont has eliminated the "stand up, sit down, wait" system that is typical of most EDs. Today, Wellmont, which now comprises 12 hospitals, has 10 EDs, and less than 5 percent of its ED visitors end up in the waiting area--down from 50 percent four years ago.

NMMC-Tupelo's Stokes has a similar story. Two years ago, Stokes' ED was well-known in the community for all the wrong reasons: 12-hour waits, angry patients, unresponsive staff. Today, NMMC-Tupelo's ED volume is up 14 percent since 2006, and its elopement rate is down--2.6 percent in September, down from 8 percent when Della-Calce arrived.

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