By Robert Frantz, MD, President, TeamHealth Emergency Medicine West Group
When the state of Nevada expanded its Medicaid program in 2014, Sunrise Hospital and Medical Center felt the impact. Located minutes from the busy Las Vegas Strip, the 690-bed hospital began experiencing higher and higher volumes of patients in its emergency department. In fact, the use of emergency services at the hospital grew by double-digits each year since the Medicaid expansion.
By 2016, the hospital had the highest emergency department volumes in the state, with approximately 167,000 annual visits.
And as patient volumes grew, so did the number of department hold hours – that is, the number of times patients wait to move to the inpatient unit after admission orders are written. On average, the hospital faced nearly 20,000 hold hours per month. In its worst month, that figure reached 28,000 hours.
Recognizing the need for solutions, Sunrise Hospital and clinical outsourcing partner TeamHealth worked together to develop a clinical integration plan to expedite the transition of patients from the emergency department to the hospital floor, reduce the overall length of stay and generally ease the burden on the hospitals’ providers.
As the hospital’s clinical services provider for both the emergency department and hospital medicine teams, TeamHealth designed an initiative to integrate the two programs under a single leadership structure. With both departments operating under one TeamHealth medical director, the hospital sought to better align the departments’ goals and streamline processes to ensure patients moved safely and efficiently through the continuum of care.
At a tactical level, the integration involved several steps. The department leaders began engaging in regular, collaborative meetings to establish and maintain accountability to the same clinical and quality standards. Each meeting’s agenda included the question, “What can I do to make your job better?” It prompted participants to think beyond their specialties to achieve cross-departmental goals. Additionally, both departments shared performance data and discussed strategies for improvement – leading to changes in the approach used during consults with admitted patients, how diagnostic testing orders are handled and the elimination of batched admissions.
The integrated team consolidated its efforts around observation patients by creating a new 30-bed observation unit with dedicated providers and case managers. And it instituted a new mandatory 7 a.m. huddle focused on early discharges.
The clinical integration initiative had a dramatic impact on patient flow within the hospital. With both the emergency department and hospital medicine teams focused on throughput, the number of patients discharged prior to 11 a.m. increased from 10 percent to 50 percent, and the hospital achieved a half-day reduction in its average patient length of stay.
With the increased capacity on the hospital floor, the emergency department could move patients through the department more quickly. Hold hours dropped an impressive 50 percent. Today, the department’s hold hours average 10,000 per month – with a new low of 6,000 achieved in late 2016.
The efforts also sparked a noticeable improvement in Sunrise Hospital’s culture and care. According to hospital COO Alan Keesee, there is much greater collaboration between nurses and physicians, with increased trust among all team members now that everyone is focused on shared goals.
Our clinical integration partnership with TeamHealth created immediate capacity, enabling Sunrise Hospital to provide a higher-level of service. And the alignment between the emergency and hospital medicine departments has contributed to improved patient and staff satisfaction.
Alan Keesee, Chief Operating Officer Sunrise Hospital