Cut Wait Times for Front-End Improvements in Flow…
Teamwork drives process improvement with CEO Janet Wagner, VP Medical Affairs Dr. Virginia Joyce, and Director of Nursing Tammy Needham, Sutter Davis Hospital, Davis, CA
Teamwork Drives Process Improvement
"It's hard to introduce new policies and procedures if you don't have solid teamwork, culture and values," explains Janet Wagner, CEO of Sutter Davis Hospital in Davis, CA. "Our ED manager, Tammy Needham, created a culture of professionalism that provided the foundation for all our achievements in the ED."
Those include raising ED patient satisfaction from the 36th percentile to the 89th percentile in the last two years; reducing LWOBS patients from over 3% to less than 1% and reducing use of traveling nurses from 11 to two to build a culture of ownership and high performance, and savings of 30% per position since 2007.
Collaboration Cuts Wait Times
When the ED team decided they could better serve patients and improve clinical outcomes by having ED nurses do blood draws instead of phlebotomists, they took the idea to one of their four interdisciplinary practice councils to review. The councils, which focus exclusively on improving delivery of patient care, are co-chaired by front-line staff who share decision making.
"Our goal was to meet CMS' core measure for doing blood draws for pneumonia patients before administering antibiotics, while still giving antibiotics in a timely way," explains Dr. Virginia Joyce, Vice President of Medical Affairs. "By allowing lab and nursing staff on the Council to work through communication issues, lab techs wouldn't worry they'd lose their jobs if nurses did these draws."
A monthly meeting of the ED team includes the ED manager and all physicians, who review key flow metrics that are tracked and reported out. "We focused closely on average triage to room time and reduced it from 31 to 18 minutes," explains Needham. "Through strong physician collaboration, we were also able to reduce average arrival to provider time from 54 to 35 minutes. The result? Fewer LWOBS patients."
Patient Satisfaction: The Other Piece
"The other piece of flow is of course patient satisfaction," notes Needham. "Patients don't want to wait to be acknowledged, wait to be triaged, or wait a second time to be put in a room. By posting our patient satisfaction scores daily, we could see our performance around arriving patients – which consistently scored low."
As a result, the ED team implemented bedside registration so patients didn't need to wait for a room; they changed expectations for triage nurses; and worked closely with registration staff to relocate staff outside the ED to greet patients on arrival. In fact, new security cameras notified nurses at the nursing station when patients were walking up so triage nurses could proactively go to greet them. Patient satisfaction for arrivals significantly improved.
EKG capability was added to every ED room's monitor. Each ED RN was trained to perform the procedure to reduce door to EKG time for chest pain complaint patients. "Now we can do EKG's even in triage since we have room for a stretcher and a curtain for patient comfort and privacy", says Needham. No more waiting for a technician with the only EKG cart to arrive.
Last thoughts? "Physician leadership in creating a culture that improves cycle time for patient throughput and patient satisfaction is crucial," adds Wagner. "Otherwise, staff will comment that physicians are not being held accountable to the new behaviors asked of everyone else. Physicians drive a tremendous number of processes and improvements."
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