Our mission at Sparrow Health System is to improve the health of the people in our communities by providing quality, compassionate care to everyone, every time. In our quest to realize this mission, each ED Team member is continually working toward improved outcomes with common goals aligned with the 5 pillars of excellence (Service, Quality, People, Resources, Growth) and behaviors that align to the I Care Values (Innovation, Compassion, Accountability, Respect, Excellence).
Sparrow Hospital is 737-bed academic medical center located in Lansing, Michigan. Sparrow has grown to become the region's largest health system, and its diverse range of facilities offer residents some of the most advanced medical technology available in the world. Sparrow has a formal affiliation with Michigan State University's three human health colleges. The Emergency Department (ED) is a 64 bed unit, Level 1 Trauma Center and has a partnership with LifeNet of Michigan for 24/7 medical transport service to enhance the region's access to Sparrow's life-saving services.
Systems of Improvement
The Sparrow ED has worked to improve its processes both in the clinical area as well as the patient satisfaction arena. In September of 2010, the ED began a journey to improve patient quality and perception of care by improving the delivery of care. The team deployed a two-track ED Process flow redesign to reduce the number of untreated patients, lengths of stay, and waiting times. The model was based on a joint research project funded by AHRQ with Banner Health and Arizona State University that included guidelines for the two-track model of care or "split flow" for patients. The model reorganizes the ED patient flow process by splitting patients into "less sick" and "sicker" subgroups based on a "quick look" rather than a full triage. Key elements of the model are described below:
"Quick look" at arriving patient: When a patient arrives in the ED, he or she gets a quick, preliminary registration and is quickly assessed by a registered nurse (RN). Less sick patients are escorted to an intake space where they await an assessment by the RN and Physician team. Sicker patients are escorted to an ED bed.
Rapid treatment for less sick patients: An RN and physician together assess the patient and review once more if an ED bed is required, and order any needed diagnostic tests. Any procedures/tests are completed at the time of the intake assessment. After tests are performed, the patient is moved to a "results pending" waiting room under the watchful eye of an RN and seated in a recliner or chair as appropriate. After tests results are released, the medical team is notified and makes a disposition decision.
Acute care for sicker patients: Sicker patients are escorted to an ED bed where a team made up of a nurse, technician, and physician conduct an evaluation and order diagnostic tests and/or treatment as needed. While the patient is in the bed, a full registration is performed. After results are reviewed by the medical team, a decision for disposition is made. Very soon, the patient will be moved to a results waiting area in the acute care area of the ED, if needed, given that a large percent of ESI Level 3 patients are discharged home after acute care.
Capacity for holding patients: Sparrow ED, like many other EDs throughout the country, struggles at times with getting admitted patients moved out of the ED in an expedient manner due to high inpatient occupancy levels and late discharges. To help, Sparrow has opened an Express Transition Unit and an Observation Unit as needed to manage these patients.
Measure the Important Things
This important principle drives the ED Team to openly and frequently review key results as a means to assess the efficacy of the model, and to make adjustments as appropriate to the prescribed treatment plan within the "split flow" model of care. Below are the improvements realized by the team after the delivery care model change
Reduction in Patients Leaving Without Treatment
Communicate at All Levels
Information is shared throughout the ED team and the organization via the work of the Unit Based Council and the ED Leadership Team. A performance dashboard that tracks and trends key outcomes drives the agenda of the weekly ED Leadership team meeting. Department communication boards are effective methods by which information is also shared throughout the department to enable support for decision making. A weekly shift-to-shift huddle was developed late last year and has replaced monthly staff meetings. The huddle template includes updated results and key points of information aligned by Pillars. The huddle is replicated every day at shift change for a week. Reward and recognition of staff is a key component of the huddle. Content changes weekly. This best practice huddle template has now been transferred across all the inpatient units at Sparrow Hospital.
Other tactics that are employed daily by the team to hear the voice of the patient and monitor performance to expected outcomes are Nurse Leader Rounding on Patients and Discharge Phone Calls. Below is evidence of the impact that these tactics have on the patients' perception of care received in the Sparrow ED.
Sparrow's vision is to be recognized as a national leader in quality and patient experience. That's a pretty bold goal, but we're already on our way.