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Concurrent projects aim to improve satisfaction
IHI initiative engenders patient-centered care
In the wake of patient complaints about long wait times and lengths of stay, the ED leadership at Williamsport (PA) Hospital took the bull by the horns and has instituted several concurrent initiatives aimed at turning things around.
The decision was made a little over a year ago based on responses from in-house surveys of patients, says Becky Hess, RN, BSN, the ED manager. They decided to participate in Boston-based Institute for Healthcare Improvement initiative, titled Operational and Clinical Improvement in the ED, she tells ED Management.
The programs at Williamsport include:
On-site patient satisfaction surveys conducted by the staff already have shown positive responses to the new initiatives: For ED patients, rates have risen from a low of 65.6% in November 2006 to 83.3% in February 2007. (The rate was 90.2% in December 2006.) For Urgicenter patients, the rate has risen from 83.7% to 88.1%. "For overall care and services in the ED, we were rated 'good' or 'very good' 89% of the time," Hess adds.
In addition, she reports that:
Service with a smile
Patient service representative Barbara Wilson starts interacting with patients as soon as they come in the door.
"Basically, I go out and introduce myself, and see if they need something — like a wheelchair," she says. "Once they are seated and comfortable, I hand them a survey and ask if they can tell us how we treated them throughout the process." Wilson adds that she will not ask this of a patient who is clearly not feeling well. When the patients have completed the surveys, they can give them back to a patient service representative, return them using a self-addressed stamped envelope provided by the hospital, or use one of several drop-off boxes in the department.
Once a patient has been waiting more than half an hour, she will ask if she can get them a drink; if they and their family have been there considerably longer, she will also offer free sandwiches, which she obtains from the cafeteria. "I'll ask if they need a blanket — and if they say yes, I will give them a warm one," she adds. Wilson will also frequently update the patients on their stage of care and how soon they will be tended to.
According to Hess, there are 12 patient service representatives. There is double coverage in the ED every day from 9 a.m. until 6 p.m. "We wanted to put somebody in place to update patients, let them know what's happening, and keep them comfortable while they are waiting," she explains. "We are also working on the 'back end' to get rates down."
Speeding up processes
Several steps have been taken on the patient care end to speed care processes, starting with the "pool-til-full" concept, Hess says. "Instead of doing a full triage in the morning, we will take the patient right back to the ED, get them worked up right away, and have a doctor see them quicker," says Hess, noting this was made possible by adding bedside registration.
In addition, she says, the department set a time limit of under 15 minutes for bed placement. "All inpatient units are on board with that," she says. "We worked through a process where a staffer is assigned on each unit to be aware of where the empty beds are, so when they get a call they already know where the next patient needs to go."
Targets set in Urgicenter
In the Urgicenter, which handles the less acute cases, there had not been an emphasis on getting people seen and out quickly. "We set some targets for ourselves," Hess says. "A lot of the improvement has been staff awareness of a need to cut times down." In addition, there are no longer any physicians working directly in the Urgicenter — just PAs. "We have double PA coverage from 10 a.m. to 9:30 p.m. and an extra nurse during that same time period, seven days a week," Hess notes.
In terms of throughput, Hess says she has initiated some protocols the nurses follow, based on presenting symptoms, to get lab work and X-rays done before the physician provider sees them. Hess also has changed the in-house survey process, which she believes will further enable her to obtain more positive patient responses. In the past, the department used mail-back patient satisfaction surveys. "People who have a complaint are more likely to get the information back to you," she notes. By employing the patient service representatives to solicit responses while patients are in the ED, she says, she is not only able to hear the good news, but she is receiving much more input in general.
"Using the mail-back, method, for example, in October 2005, we had 21 the entire month," says Hess. "This month, we had 273."
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