Facility: Sharp Grossmont Hospital in San Diego, CA
TeamHealth Services: Emergency Medicine Staffing
- 62% Reduction in low-acuity patient length of stay (LOS) from 410 to 156 minutes
- 82% Reduction in left without treatment (LWOT) percentages from 4.45% to 0.8%
- 7% Increase in patient satisfaction scores
- Enhanced clinician communication and morale
The busy ED at Sharp Grossmont Hospital, the largest healthcare facility in East San Diego County, treats more than 100,000 patients annually. With its high-volume, the ED struggled with patient flow. Most walk-in patients transported by ambulance or with a police escort arrived through the ED’s front door, creating chaos and congestion at the triage intake area. When patients arrived, they faced long wait times and extended LOS, contributing to a high LWOT rate and low patient satisfaction scores.
TeamHealth, Sharp Grossmont’s ED management partner, organized a rapid process improvement event with a multidisciplinary team of physicians, nurses, and ancillary support service representatives from ancillary support services who worked collaboratively to identify barriers related to poor throughput and satisfaction. Those efforts resulted in TeamHealth and the hospital initiating a newly designed patient intake process that included:
- Relocation of ambulance and police-escorted arrivals to a separate entrance
- Establishment of a split-flow model where a pivot triage nurse screens patients and directs them to one of two treatment areas—AcceleratED Care for lower acuity patients and AdvancED Care for higher acuity patients
- Implementation of a treatment area for lower acuity patients who are “vertical” and a results-pending area for patients who do not need a bed while waiting on test results
Six months after instituting the new patient flow model, Sharp Grossmont experienced dramatic improvements. The new intake process helped lower arrival-to-provider time and dramatically reduced LWOT from 4.45% to 0.8%. Patient LOS in the low-acuity AcceleratED Care area fell from almost 410 minutes to 156 minutes. Clinicians also felt more empowered through their participation in the transformation, thereby contributing to improved team collaboration, communication, engagement, and morale. Patient satisfaction scores steadily rose 7% from a pre-implementation Press Ganey mean score of 79.5 to 85.6 about one year post-implementation.
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