Rounds PREVIEW: The High-Performance Emergency Department

"One of the practical things that I started to implement was to discuss the patients with my nurses," Lobón says. "As simple as that may sound, that was something that was unheard of." Lobón knew there was an issue when he showed up during the nurse triage on a patient and she asked, "Are you going to be with me in the room? I'm not used to that." When he would share his thoughts about the patient's diagnosis or treatment with the nurse, he would get another perplexed look. "They would ask, 'Why are you asking me this?' and I would say, 'Because we are working this patient together.' That concept did not exist. It was huge, huge."

Rocker, the ED nurse manager, agrees: "There's a lot more communication and team effort. We huddle going in to take care of the patient. The physician is telling us what they think. They're very open to nursing suggestions and nursing assessment pieces to the patient condition. More often the physician and nurse are evaluating the patient together. It's not one against the other. We're not waiting." 

The ED transformation achieved another of its key metrics: zero, as in the amount of capital spent. All existing staff and space was reallocated.

"You work with whatever you can," Sayah says. "It's more of a function than a location or a physical plan." Part of the solution was as simple as replacing desks with beds in former registration rooms.

Additional lessons in the full case study are: Lesson 2: Fix the flow outside the ED; Lesson 3: Install leadership and compensation structures to build physician culture; and Lesson 4: Invest in the ED as a strategic part of integrated delivery enterprise.

Reprint HLR0312-10

This article appears in the March 2012 issue of HealthLeaders magazine.