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Why Is The ED Such A Pain?

Molly Rowe, for HealthLeaders magazine, January 15, 2008
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"I used to spend my day on the phone apologizing, but now there's not a day that goes by that I don't get a thank-you letter or an e-mail," says Della-Calce, who implemented several new processes designed to elevate customer service. Staff members escort patients to rooms--they don't point, Della-Calce says. Once patients are in rooms, nurses round on them every hour to see how they're doing and update their status. White boards in every patient room let patients know who is taking care of them. At shift change, the arriving and departing nurses go in as a team and conduct a bedside report with the patient. Additionally, nurses make discharge calls for every patient who was treated and released the day before to make sure patients understood discharge instructions and were able to schedule any necessary follow-up appointments.

NMMC-Tupelo's Press Ganey patient satisfaction scores were less than 1 percent in the ED two years ago. Today, their scores average in the 70s.

"I was standing at the nurse's station one day, and one of the nurses said, 'You know, our patients actually like us now.' That was kind of the turning point," says Della-Calce. "They realized that it didn't have to be a hostile environment."

Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.


Fast Care-Guaranteed

Volume growth in the emergency room is the last thing a lot of hospitals want to see. But at Allen Community Hospital in Oberlin, OH, leaders had made all of their process changes, improved patient satisfaction, and even moved to a new space. They had a bigger, more efficient ED--but no patients to fill it.

So they used an old-fashioned customer service ploy, the guarantee, to increase ED volume. The promise? Patients in the ED will be triaged within 15 minutes of arriving in the ED and seen by a physician within one hour or receive a gift certificate.

The "one-hour wait or less" guarantee kicked off in February 2003 after an extensive marketing campaign in local newspapers and on billboards. On the day the guarantee launched, Allen Community's ED saw more patients than it had ever seen in one day. Over the next three months, emergency room visits per day were 41 percent higher than they were the previous year. Allen Community's ED will see about 21,000 patients this year, more than double the patients in 2002, and word of the guarantee (which staff meets 99 percent of the time) has gotten out.

"The staff at one of the other hospitals actually said to a patient, 'Why don't you just go over to Allen because you can get in and out right away?'" says Susan Bowers, Allen's vice president of patient services.


Culture Clash

The emergency department is a unique animal in ways both large and small. Consider:

Rest of the hospital
Patients a nurse sees in a day: A dozen or less
Typical physician: Specialist
Time to make an impression on patients: 24 hours or more
Meal plan: Wood-grilled pizza, made to order
Accommodations: Individual room (with or without a roommate)

ED
Patients a nurse sees in a day: 50 every 12-hour shift
Typical physician: Jack-of-all-trades
Time to make an impression on patients: Less than 4 hours
Meal plan: Peanut butter crackers and Diet Coke
Accommodations: A hallway bed, privacy curtains, TV

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