Jersey City Medical Center
To improve its operations, Jersey City Medical Center, which sees nearly 84,000 patients a year, took a structured approach toward re-engineering its emergency department patient flow. The results of this project, which was implemented in mid-2010, have been extremely impressive. The initiative created a more efficient flow process, decreasing average arrival-to-first-provider times, among other measures.
To realize these operational efficiencies, the ED leadership team took a Lean and Six Sigma approach toward first reducing arrival-to-first-provider times in its Fast Track area. After forming a workgroup to research this, the team was able to reduce the number of steps in the process between the patient’s arrival and when he or she saw the provider. The longest step to be eliminated was the up-front registration process. Previously, patients were seen by a triage nurse and then remained in the waiting room to be registered. Now, patients are brought to the Fast Track area as soon as treatment space is available, and registration is completed at the bedside. By eliminating the registration wait time and reinforcing the concept of direct bedding, arrival-to-first-provider times have been reduced significantly.
To measure the success of the project, the ED leadership team needed to know how the department was performing prior to the implementation of the improvements, and then develop targets and goals for the project based on that data. ED Solutions, Emergency Medical Associates’ consulting arm, played a key role in providing the data necessary to determine current performance, and the tools to monitor the established targets and goals to measure the success of the project.
A room was dedicated to patients awaiting disposition, which helped increase the ED’s capacity. Additional Clinical Information Managers (CIMs®), who function as provider scribes, helped further improve provider productivity.
As a result of this effort:
- Fast Track arrival-to-room times decreased from a median of 44 minutes to 17 minutes.
- Prior to Emergency Medical Associates, only 9 percent of patients were brought to a room within 15 minutes; this number increased to 42 percent after the initiative’s launch.
- Before Emergency Medical Associates, only 35 percent of Fast Track patients were discharged within 90 minutes; this increased to 62 percent
- Fast Track arrival-to-provider times decreasing from a median of 50 minutes to 27 minutes, which translates into nearly a 50 percent decrease.
- Before Emergency Medical Associates, 22 percent of patients were seen in 30 minutes, which increased to 60 percent following the initiative.
Perhaps most impressive is the fact that the department’s gains have been sustained during the last 18 months, during which time it experienced a 6 percent increase in volume. This increase in volume resulted in about $1.2 million in additional revenue since the implementation of the project.
Nyack (N.Y.) Hospital was facing challenges typical of most emergency departments. The average ED length of stay was greater than 8 hours, walkouts exceeded 3% and patient satisfaction was at a challenging 17th percentile.
Once Emergency Medical Associates (EMA) partnered with Nyack Hospital, strong efforts were made to establish the ED as a highly efficient clinical operation. This included the provision of an experienced medical director, an ED operational support team to assist with strategy and implementation, an ED information system and analytics and dashboards.
Through the resources provided by EMA, Nyack Hospital was able to redesign its processes and introduce a 30 Minute Service Standard, where patients would be seen by a provider within 30 minutes of arrival to the emergency department.
The result was a reduction in walkouts to 0.5% (well below the national benchmark), nearly a 50% decrease in length of stay and a vaulting of patient satisfaction as high as the 99th percentile. Within the next 12 months, Nyack Hospital saw its volume increase by 17%, attaining dominant market share and favorable recognition as a quality provider of emergency care in the community.
Clara Maass Medical Center
The emergency department (ED) at Clara Maass Medical Center in Belleville, N.J., experienced steady volume growth over the past few years. With a 25% increase within the last 2 years, the challenge to manage the demand was very clear. Not only was there a need to expand capacity but also a need for changing operations to accommodate the growth without sacrificing quality and efficiency.
With EMA leading the effort, the medical center created a Rapid Decision Unit (RDU) adjacent to the ED. This was used for evaluation and treatment of patients who required further testing to determine if they required admission to the hospital. Operating the RDU allowed the ED to function more efficiently while simultaneously removing patients requiring further testing to a more comfortable and appropriate setting. In addition, quality of care was enhanced through better decision-making when admitting patients, and effectively reducing unnecessary admissions to the hospital.
Prior to the RDU, walkouts were nearly 6%, with a turnaround time of nearly 9 hours for admissions and almost 4.5 hours for discharged patients. One month after opening the RDU, the walkout rate was reduced by 50% as turnaround times began to decrease as well. In one year’s time, walkouts had been reduced to .8%, well below the national benchmark of 2%, while turnaround times for discharges and admissions decreased by 28% and 12%, respectively.
The ED is on track to see more than 70,000 patients annually with no signs of slowed volume growth. Thanks to the RDU initiative and Emergency Medical Assocaties' resources, those patients will receive expeditious care of the highest quality.