Faster emergency care
How new policies—and teamwork—have helped reduce waiting times by 25 percent
How new policies—and teamwork—have helped reduce waiting times by 25 percent
If you’re sIck or Injured enough to need to visit an emergency room, you’re already under a lot of stress. You don’t need that anxiety compounded by inefficient staff or long waits. that’s why Monmouth Medical Center has expanded its emergency department, now called the cline-d’onofrio emergency services Pavilion, and introduced new policies to assure that patients receive comprehensive care as quickly as possible.
Nobody’s happy to be in the emergency room. But it only stands to reason that patients are more satisfied with their care when there’s less waiting time to endure, and Monmouth Medical center has made sure wait times have come down. the result? “Patient satisfaction” scores for the ED have gone up. They were in the 69th percentile for the last two quarters of 2008, says the survey firm Press Ganey, but rose to the 91st percentile by this year’s second quarter.
“Nothing is ever routine about an ED, and you never know what’s coming,” says depart-ment chair Catherine Hanlon, M.D. “so if the proper systems are in place, it makes handling whatever comes a whole lot better and easier for both staff and patients.”
The first step in lowering wait times was holding staff focus groups on every aspect of emergency care. “We looked for any blocks at each point and assigned people to find ways to improve them,” Dr. Hanlon says.
Because the number of emergency department admissions has jumped dramatically in recent years, the hospital expanded the department by adding eight beds, enlarging the triage area and creating a new Quick Care section to deliver treatment for nonemergency complaints such as ankle sprains, sore throats and minor cuts and burns.
That frees up space for more serious problems, and those have been fast-tracked as well. Patients can now go right to an examining room, where a technician can take vital signs, a registrar can collect personal and insurance information and a nurse can begin treatment—all at the same time. “We have prewritten, standing orders for several conditions that the nurses can follow,” Dr. Hanlon says. “they can order pre-specified blood work or imaging tests so that the results are ready by the time the doctor sees the patient. We can also fast-track X-ray studies.”
Available space can pose another roadblock to satisfactory care if an emergency patient needs to be admitted. According to Dr. Hanlon, being prepared and having a streamlined process are key. “for instance, if there are no hospital beds ready and I have patients in the ED who need to be admitted, everything slows down—including our ability to get to new ed patients,” she says. so new procedures were adopted to improve scheduling and facilitate quicker discharge from the hospital, freeing up beds for new arrivals.
“Every area of the hospital needs to work together to achieve these goals, and I’m proud to say that everyone is on board with our efforts,” says the doctor.
New computer hardware and software at every point in the process also helps speed up care. the result: overall wait times in the ED have decreased from about 4 hours to under 3 hours, dr. hanlon reports. People with minor complaints are in and out in an average of 64 minutes. for patients admitted, the average time it takes from arrival at the ED to when they’re in their beds has dropped from more than 8 hours to 6.4.
Patients aren’t the only ones who are pleased to see the improvements. “Staff morale has risen, because improved systems and processes make it easier for them to perform too,” Dr. Hanlon says. “And I think patients pick up on that.”
