9. Excellence in response: a hospital–wide journey in improving throughput for the ED patient

Abstract

Clinical Topic: The intent of this project was to develop and implement a hospital-wide program aimed at improving the throughput of the ED patient. The rationale for this program was driven by several factors: a desire to increase market share; community focus groups' identification of 3 things they were looking for from their health care providers—quality, efficient, and timely care; the emergency department is the “front door” to the hospital, and 60% of all inpatient admissions come from the emergency department. Implementation: Planning and implementation included the following steps: (1) obtaining administrative approval and commitment to the house-wide effort; (2) identifying the goal time by which all patients presenting to the emergency department should be seen by a physician or treatment initiated following specific protocols (30 minutes); (3) identification by all departments of their specific and measurable goals toward success, based on their function and how it impacts the ED patient; and (4) house-wide “pep” rallies with Excellence in Response “giveaways” for all staff and commitment pledge signing activities. Outcomes: Excellence in Response has resulted in a culture change for the entire facility. Examples include (1) 93% of 76,000 patients seen in the emergency department in the first year after implementation were seen/treatment was started within the 30-minute goal. The baseline measurement for this goal at implementation was 56%; (2) Patient satisfaction and loyalty scores have improved from running in the 40% range to now in the 80% range; (3) Improvement in staff and physician morale is not measured, the change is palpable; (4) daily review and accountability, by all departments, for the previous day's success at meeting their goal; (5) regularly scheduled, multidisciplinary review of barriers to success; and (6) significant contribution in SSM Health Care's efforts to win the Malcolm Baldrige National Quality Award. Recommendations: Recommendations for improving ED patient throughput resulting from this experience include (1) obtaining administrative support and commitment for the goal; (2) presenting Excellence in Response as the culture of the facility during new employee hospital orientation; (3) annual renewal of the commitment to the goals of Excellence in Response by all hospital staff; and (4) regular, multidisciplinary review of any barriers to success. This would be an appropriate undertaking for any emergency department that struggles with bottlenecks due to fluctuations in patient volume and inefficient hospital processes that impede patient flow.