I recently came across this case study on how one hospital undertook system wide improvements and small “tests of change” in an effort to improve their patient throughput.
I like this idea because it helps show that undertaking small changes using “innovation and creativity instead of capital,” as the hospital wrote, can yield improvement in key metrics.
Carondelet St. Mary’s Hospital in Tucson, Ariz. was looking to lower the number of patients who left without treatment 34 percent to 2.89 percent and reduce the length of stay for admitted patients from 8.85 hours to less than 5 hours — an improvement of 74 percent.
Spoiler: They did it! How you ask?
Here were the tactics they tried:
- They worked on better predicting capacity and demand. Inpatient units worked on identifying patients who were a high potential for discharge from the ED the following day and these were communicated via an electronic bed tracker.
- They worked on stepping up their communications game. Rather than just relying on one communications handoff they incorporated more regular reporting in a variety of formats including: electronic daily reports, weekly reports, and month comparisons year over year.
- They assigned nursing staff very specific, specialized roles. One became specifically responsible for triage, another for rapidly placing patients in Emergency Center (EC) beds, and another focusing on discharge and transfers in the patient flow process. Allowing nurses to specialize on one task, for example, getting a patient through a certain area of the emergency department in a specified number minutes helped them stay focused on their work rather than having to wear many hats and clarified areas of responsibility.
- They weren’t afraid to bring in a triage nurse practitioner during peak times. Triage NPs were initiating medical screening exams with medical orders so they could reduce “wasted wait” time and initiate treatment more timely.
- By adopting new real-time technology — EC using Dracker and Teletracker interface — to request beds for inpatients they were also able save time.
Have you tried similar “tests of change” in your emergency department and had success?
If you’d like help in evaluating where you might be able to try some changes to produce results, contact me. I’m happy to help evaluate your emergency department and get you started on a path to being more efficient.