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Nyack Hospital
Nyack 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: 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
Clara Maass Medical Center's Emergency Department (ED) 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 to change operations in order to accommodate the growth without sacrificing quality and efficiency.
With EMA leading the effort, Clara Maass Medical Center created a Rapid Decision Unit (RDU) adjacent to the ED. This was utilized for evaluation and treatment of patients who required further testing to evaluate 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 by better decision making towards 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. At 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 greater than 70,000 patients annually with no signs of slowed volume growth. Thanks to the RDU initiative and the EMA resources behind it, those patients will receive expeditious care of the highest quality.
Meadowlands Hospital Medical Center
The Emergency Department at Meadowlands Hospital Medical Center (MHHC) treats approximately 20,000 patients annually in a community hospital setting. When EMA began working with MHHC, the overall satisfaction scores were in the 17th percentile. On average, it was taking almost 40 minutes from the time of arrival before the patient was seen by a provider with only 56% of patients being seen within 30 minutes of arrival. This resulted in walkouts being nearly 2%.
Utilizing EMA's experience with improving patient satisfaction and ED operations, the ED leadership group developed a task force that utilized Six Sigma methodology and Kaizen events to redesign the process flow and eliminate bottlenecking.
With EMA's on site operational support, the new process flow was launched and monitored carefully with ED staff buying into the project.
The results of the implementation have been dramatic as the mean arrival to first provider time was reduced by about 19 minutes (52%) and the walkout rate reduced to 0.77%. Most importantly, the ED staff has identified that it is easier to work in the department since their patients are happier with the reduced waiting times. The patient satisfaction scores reflect this with dramatic improvement to the 74th percentile ranking in a matter of months.
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