Challenge
In 2013, Nash General Hospital struggled with negative reviews of the emergency department from the community thus losing patient volume. Patients were frustrated with long wait times, as reflected in their high left without being seen rates and patient satisfaction scores. With a keen focus on being the community’s hospital of choice, NGH turned to TeamHealth.
Solution
The linchpin of success in implementing and sustaining successful programs relies on strong leadership. TeamHealth recruited a facility medical director, whom initially turned down the position until learning of the support and resources TeamHealth provides clinical leaders. With TeamHealth’s support the medical director became more involved in the hospital and engaged in meeting the hospital’s goals. Dr. Moore equally became more involved in the community through student club presentations and EMS in-services. Though he made significant strides in changing the culture to a collegial atmosphere, work still needed to be done.
TeamHealth’s Performance and Innovation Consultant, Liz Harris, RN, conducted a Table Top Exercise that involved a simulation of the last few days in the ED to help discover bottleneck causes. Once everyone was aware of the core problems they developed solutions, as a team. Communication improvements included notifying the provider when labs were ready, dedicated response to EMS calls, and appropriate use of triage. Dr. Moore and Amy Winham, ED Director, met weekly to review process changes and outcomes, tweaking processes when outcomes didn’t meet expectations. Even a skeptical CNO was pleased with the results and culture change!
Results
The most noticeable reflection of success was the volume surge of 8 percent within the first year. Door-to-doctor times decreased by almost an hour and average length of stay for discharged patients dropped to 177 minutes – surpassing the goal of 188 minutes.
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