Appointing emergency room "czars" to manage hospital beds, placing patients in recliners if they don't need an ED bed, and contracting with whole physician groups to take responsibility for ED calls are three strategies that can help hospitals remove bottlenecks that waste acute care resources.
Likewise, explaining specific timeframes to patients and using volunteers to help answer patients' questions can improve the emergency room patient's experience.
Creative thinkers in emergency medicine described these and many other ideas during the first HealthLeaders Media Rounds Tuesday at Scripps Memorial Hospital in La Jolla, CA.
"Our emergency rooms are the front doors to our hospitals in many cases, and regardless of what happens in health reform, our patients expect, and should expect, excellent service, rapid service, and appropriate doctors on call and available when they need them," said Chris Van Gorder, president and CEO of the five-hospital Scripps Health system in San Diego.
Panelist Michael O. Ugwueke, CEO and administrator of 200-bed Methodist South Hospital in Memphis, described his facility's effort to reduce ED wait times and improve patient satisfaction. During a three-year campaign, he gave patients $20 gift certificates and wrote them letters of apology if they weren't seen in the ED 30 minutes after they arrived.
They improved those satisfaction scores in part by increasing the number of triage bays, and instituting a nurse-managed fast track system.
"Everyone who comes to an emergency room thinks they have an emergency," Ugwueke said. "So you have to look at it from that standpoint."
Other panelists included Scripps Chief Medical Officer Brent Eastman, MD, who described Scripps' use of so-called czars or "czarinas," professional emergency room pathfinders who are given authority to make decisions that unclog the typical bottlenecks that thwart patient flow from the emergency room.
"This is not in a czar in the Russian [sense]," Eastman said, likening the typical bottleneck as the hospital's proverbial "bowel obstruction."
"This is all about shared governance between physicians and nurses and technicians. The emergency physician actually gets out of the department . . . out into the hospital looking and seeing about the beds and seeing what's available," said Eastman, who is also the chairman of the Board of Regents for the American College of Surgeons.
Such a person "must have the accountability, authority, and frankly, responsibility to make decisions, because if no one makes decisions, we're going to have that bowel obstruction."
Eastman also described a "low-tech" strategy at Scripps Mercy Hospital, where emergency teams now triage patients, and put those who don't need a bed into a reclining chair instead. He said Mercy has "doubled their capacity without adding beds, and taken wait times from five hours to two hours, and reduced the [number of those who] leave without treatment from 8% to 2%."
Jedd Roe, MD, chief of emergency medicine at William Beaumont Hospital, a 1,061-bed facility in Royal Oak, MI, described an experiment that improved patient satisfaction scores at his facility. Beaumont prepared "scripts" in which emergency room staff would explain to patients how long—with much more detailed layers of specificity than is typical—a procedure such as a test, might take and when the results would be ready.
"What I found was that patients realized that now they could plan," Roe said. They might think, "Maybe I have time to run home and feed the dog, or go to the cafeteria, and bring something back for the patient."
Robb White, RN, director of emergency services at Tomball Regional Medical Center in Tomball, TX, a 357-bed facility, stressed the importance of checking the statistics of where patients are in the hospital every day, not where patients were the day before, and publishing it so everyone in the hospital understands the problems.
The next HealthLeaders Media Rounds "Cancer Service Line Success: Better Coordination, Better Outcomes" is scheduled for Tuesday, March 30 at Banner Health.