Hospital working to cut ER wait time

June 16, 2011 - Download Word Doc

Natchitoches Regional Medical Center emergency department has improved the average ER wait time from almost 2 hours to 35 minutes.

"In the last three months, we have cut the ED (emergency department) waiting time to an average of 35 minutes," said Pat Spillman, vice president for patient care. The emergency department includes the emergency room and all emergency staff from doctors and nurses to EMTs.

The previous average waiting time was 1 hour and 50 minutes. NRMC's goal for each patient's waiting time is less than 10 minutes. One week the department averaged only 8 minutes, but wait time can fluctuate daily depending on the types of emergencies and number of people with emergencies.

The department sees an average of 50-55 people a day, about 18,000-19,000 a year. The ED recently saw 75 patients in one day, which was the highest number recorded in a long time, Spillman said. The emergency department has 24 nurses and five physicians. One doctor works per shift except in large-scale emergencies. Another improved statistic is the number of people who leave the ED without being seen. That number decreased from 10 percent to 0.06 percent leaving without being seen by a doctor.

"We recognize the fact that over the years we've had many complaints on wait time," Spillman said. "It's something that should've been done - if we'd known how - a long time ago."

The hospital contracted with Ryerson Healthcare Consultants, a firm that specializes in the financial and operational performance of healthcare providers. They have assisted more than 500 facilities nationwide develop and implement a comprehensive action plan that improved patient flow, expedited the admission process, improved documentation and coding and enhanced communication between patients and physicians, according to a hospital press release.

Ryerson representatives conducted interviews in March with senior leadership and department managers and medial staff to assess the emergency department services, identify areas for improvement and to make recommendations for improving "door to doc" time, easier admission process, better customer service and improved efficiency. The hospital was given a timeline for implementing the changes. Ryerson representatives have completed three follow-up visits.

"No one ever gets better sitting in a waiting room," hospital CEO Mark Marley said. "That's why we have committed ourselves to getting patients in and out of the ED quicker. Our new ED service initiative promises better care by focusing on what our patients expect: to be greeted promptly, have their individual needs accommodated, taken immediately to a private triage room, receive clear explanations about their care and easy to understand discharge instructions. By going through this process, we will be well prepared to accommodate the continuing increase in the number of patients that come to our hospital for emergency care."

Patient satisfaction scores, recorded through the national healthcare improvement company Press Ganey, have also improved 50 percent since January. The goal is to get the patient from "door to discharge" in one hour. Press Ganey conducted an external audit of the hospital, as it does for about half of the hospitals in the country. Spillman said patients are encouraged to fill out the questionnaire they receive from Press Ganey after discharged and the results are recorded.

The hospital has worked with Press Ganey for five months to raise patient satisfaction from the first, and lowest, percentile of the hospitals the company monitors to the 66th percentile - a significant increase since January.

ER Nurse Manager Ruth Hubbard began implementing the suggestions from Ryerson in March and saw the hospital's patient satisfaction rank jump from the 10th percentile to the 66th in May. Hubbard expects the upward trend to continue. The hospital's goal is to reach the 87th percentile, which is average.

Spillman said NRMC wants to make sure patients feel they are being well taken care of and not ignored. She recognizes that a long wait time for a sick person can spiral into a very bad situation. They're agitated by the time they get back to see the doctor and are not cooperative, which affects the doctor and staff, she said. Shorter wait times can prevent that.

"Now the whole relationship between the patient, doctor and nurse is a lot better," she said. "The staff is very proud of this accomplishment and our visitors to the ED seem to be pleased as well. Not only have our scores increased, but we've gotten compliments. It's been a very good experience. A lot of credit goes to the physicians and nursing staff for their hard work in this program"

by Leigh Guidry

2011 - reprinted with permission, Natchitoches Times