Skip to main content

Engineering a High-Performance Emergency Department

 |  By Jim Molpus  
   February 07, 2012

 

The list of real challenges to emergency department improvement includes the fact that the ED is open 24 hours a day to treat anything from a scratch to a stroke, requires a multi-disciplinary team of doctors and nurses to work together quickly and efficiently, and for good or bad often represents the patient's impression of the hospital as a whole.

The leadership team at Massachusetts-based Cambridge Health Alliance faced the same challenges as any ED but with a few of its own, including its mission as an urban safety-net provider. Capital for expansion and renovation was limited.



So the team undertook a series of operational and clinical initiatives, including a review of throughput, a new staffing model for ED nurses, and boosting compensation along with accountability for physician performance.

In a new HealthLeaders Media Rounds case study, Create Your High-Performance, Patient-Centered Emergency Department the physician, nurse and executive leaders dive into specific steps they took to dramatically improve key ED performance metrics, including ambulance diversions, wait times, door-to-admit times and others.

As with any performance turnaround, the specific steps are enabled under a protective cover from leadership, including:   

 

Commitment from the top
It may be one of the most-used clichés that any initiative undertaken at a hospital must have the mandate of the highest-levels of clinical and executive leadership to succeed. But saying that and meaning can that drive two different results and this is "where a lot of EDs fail," says Assaad Sayah, chief of emergency medicine at Cambridge Health Alliance.

Sayah says engineering something like patient throughput in the emergency department often requires "heavy lifting" in many departments that connect to the ED.

"This is basically where a lot of EDs fail," Sayah says. "Any ED can re-engineer their front end but it takes an institutional commitment to work on the throughput piece. And without that, it will fail."

One example for leadership having a stake on an issue like throughput is "code help," an alert system CHA put in place that allows for a clinical manager to call for help when the ED is clogged.

"Everybody gets called all the way from the administrator to the CEO, CMO, CNO and housekeeping," Sayah says. "It's all hands on deck. The idea is within 30 minutes the admitted patients will leave the emergency department and go upstairs to the floor."

The benefit is not just in the immediate fix, and the code is only used maybe twice a year, Sayah says. Knowing that leadership is available to help manage the situation has its own real and symbolic benefits.

 

A holistic view of the ED
Whether it is in investments in IT, or thinking about the larger physician staff, hospital leadership may have to view the ED as the hub of a larger clinical enterprise. So maybe the best investments that one can make for the ED might be in the primary care network. And perhaps putting the ED first is not always the best way to achieve results.

The ED was not the first department to go online as part of CHA's decade-old, system-wide electronic medical record implementation based on an Epic Systems platform. Bedside tracking and registration in the ED began two years ago after years of implementation on CHA's ambulatory network.

 One of the benefits was that the physician's office—and not the ED—became the first stop for gathering patient history and other information that would have inevitably fallen on the ED had they been first, says Laura Nevill, RN, senior director for nursing informatics. "Their time in the triage would have gone from three minutes to 23 minutes because they'd be spending so much time trying to put in the medical and surgical history and the meds," Nevill says.

For more specific performance takeaways, additional resources, and registration to the exclusive live Rounds event featuring Cambridge Health Alliance on March 29, click here.

 

See Also:
From Bleeder to Feeder: How an ED Turned Its Business Around

Jim Molpus is the director of the HealthLeaders Exchange.

Tagged Under:


Get the latest on healthcare leadership in your inbox.