Retrieving a Reputation: A Story of an ED Turnaround

Abstract

Purpose: The Emergency Department of a large suburban, level 2 hospital has been associated with very long waiting times (an average of 18 hours from presentation to disposition), hallway beds as regular treatment areas and a 13% left without being seen rate. Staff morale was low; turnover was high and all ED functions were dysfunctional. A decision was made to turn the ED around from all facets--administrative, physician and staff. The process started with the appointment of a new ED Director and quickly there were expectations of high standards and an atmosphere of nurse empowerment that could lead to change. The journey began with the collection of data, the readjusting of hardwired behaviors and the holding of all staff members accountable for patient satisfaction scores (6th percentile) and the very negative reputation in the community. Instead of hiding what was wrong in the department, transparency was in vogue and the mission of upper and middle management was now to tell the story of the department as it progressed in the quest for excellence. This ED achieved all goals and today enjoys a fully staffed ED, without travelers, patient satisfaction above the 90th percentile, left without being seen below 2% and a renewed reputation. It also now sees 33% more patients per month. This is truly a story of a planned ED turnaround that has many lessons for ED's in similar conditions.<br/><br/> Design: This was a collaborative, realistic goal setting effort. That would have reliable measures, accountability of its team members.<br/><br/>Setting: This ongoing project is being carried out at a level 2 suburban community hospital in the Deep South.<br/><br/>Participants: All staff and physicians within the adult ED.<br/><br/>Methods: The Press Ganey surveys were used. Data was compared to other hospitals with similar volume. Studer rounding tools; staff engagement; physician partnership and research data are among the methods used for overall improvement. Outcomes are evaluated using Length Of Stay (LOS), Left Without Being Seen (LWBS) and patients leaving Against Medical Advice, (AMA); data is collected monthly. <br/> <br/>Results: Data was measured from June 2008 to June 2009. In June 2008 Visits were 4,679 compared to 6,200 in June 09. LWBS was 5.1% compared to 2.0% in June ô09. AMA was 0.7% in June 08 vs 0.6 in Æ09, the admission rate dropped from 39% in 08 to 35% in Æ09. However patient satisfaction went up significantly from the 33rd% to 95th% in spite of increased volume. <br/> <br/>Conclusions: Leadership had to be held accountable for consistently engaging tools that are evidence-based. Management championing of hourly rounding and other methods that increased patient and staff satisfaction, had to be consistent and sustainable in order to improve staff and patient satisfaction while decreasing AMA and LWBS. Staff had to be presented with data, and the rationale for hardwiring rounding, which entailed both the management team and staff rounding on patients daily and hourly respectively.<br/>