Background

In an urban medical facility, home to 400-inpatient beds, 40-ICU beds and the representation of all specialties with the exception of plastics, ENT and pediatrics, one ApolloMD partner offers tertiary care to local residents and the surrounding communities.

In July 2016, a new medical director was named for the 44-bed emergency department (ED) which sees approximately 65,000 visits per year. The team is now staffed with 11 physicians and seven APCs with approximately 46 hours of physician coverage and 40 hours of APC coverage per day. Over one year’s span, this high-acuity ED made several operational changes to improve efficiency.

  • Hospital Beds: 400-beds
  • ED Beds: 44
  • Annual Volume: 65,000
  • High-acuity department
  • Daily Physician Coverage: 46-hours
  • Daily APC Coverage: 40-hours
  • Practice Size: 11 physicians and 7 APCs

The Challenge

Prior to hiring a new medical director, the ED was facing a number of operational challenges. As a result, the hospital’s metrics revealed prolonged arrival to provider times, high left without treatment (LWOT) rates and unacceptable time to admit and discharge turnaround times.

The Approach

The ED medical director and team members approached four key elements to get the ED back on track.

  • Define the Goal: A common standard was determined and communicated to all department team members and other key stakeholders routinely to compare metric progress and develop improvement solutions.
  • ED-Hospital Alignment: A cohesive admission protocol was established to benefit both the emergency department and inpatient team.
  • Front-End Flow Implementation: Implemented new paralleled process to compress traditional process and decrease wait-times.
  • The Pivot Process: Built a customized queueing system to focus on LWBS improvement.

The Result

In October 2017, the ED achieved a level of success far beyond what was experienced in the prior 24 months.

Across the entire health system, 77 hospitals, 20 surgical hospitals and 460 outpatient centers, the ED ranked among the top 10 in three metric categories.

  • Ranked No. 1 in Median Care Complete to Admission – 34.7 minutes
  • Ranked No. 2 in Median Admit LOS – 192.9 minutes
  • Ranked No. 5 in Walkout Rate – 0.75%

In addition, improvements were seen in the following areas:

  • Decreased Time of Arrival to Time of MSE: Approximately 30-minutes on average
  • Decreased Left without Triage Rate: Previously averaged 138 patients per month which decreased to 4 patients total LWBS
  • Decreased Average Patient Admission Time: Averaged 2-hour reduction from door to inpatient bed
  • Decreased Turnaround Time to Discharge: Approximately 67-minutes