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ED initiative adds $20M in revenues
Lower LWBS rate, volume bring benefits
A process improvement project addressing the entire emergency service line at The Medical Center of Central Georgia in Macon is expected to increase hospital revenues by $20 million — $24 million this year, according to DeLanor Doyle, MD, FACEP, the medical director of the emergency center.
Currently, revenues are $2 million to the positive side per month. This amount represents a 40-to-1 return on the fees paid to Compirion Healthcare Solutions of Elm Grove, WI, the firm that worked with the ED to design and implement the project, which was paid fees of about $500,000.
The accomplishments of the project, initiated in June 2008, include:
One of the most significant changes was to change the triage area in the front of the department into a "triage and treatment" area, says Barb Stickel, MSN, RN, senior vice president and chief nursing officer. "We utilized unused areas as treatment areas," she explains.
Doyle adds, "We had a little quick care area next to triage that we started using, and triage rooms themselves were used as treatment areas, and we just triaged in a smaller area."
In addition, nurse practitioners and physician assistants were brought to the front and, when needed, doctors, says Doyle. "So, instead of them just being triaged and waiting up to 15 hours, we can see them and have them out much more quickly," he says.
To handle the increased volume in the ED, more beds on the floors needed to be available during peak hours. To address that issue, another new process that was implemented has been named "Code Census." "When we realize we're getting backed up, we will call an alert to the staff on a housewide page," explains Stickel. "If we do not see the nurses are refocused on getting discharges moving within a reasonable period of time, we send another message: We play a few bars of the 'William Tell Overture.'"
This unorthodox approach has proved to be quite effective, she says. "It's amazing, but within 30-45 minutes, the beds have freed up," Stickel shares.
Another recommendation involved moving the chest pain center, which originally was located on another floor, into the fast track area closer to the ED. Fast-track patients are now being seen via the new triage and treatment process. This way, the chest pain specialists, who are also emergency physicians, can assist in the ED.
"Overnight, the two physicians cover the chest pain center as well as the ED," notes Doyle. "The physicians in the ED now see more patients per hour than ever before."
Team meetings spur quick results
Generating projected revenue increases of $20 million to $24 million is impressive enough, but accomplishing the task in less than a year is really remarkable. How did The Medical Center of Central Georgia in Macon do it? By laying a solid foundation with the help of Elm Grove, WI-based Compirion Healthcare Solutions.
"Starting in June 2008, we sat down with them and our nursing group, our medical director, and our administration, and at the very beginning we developed what metrics we wanted to improve and determined our baselines," recalls Barb Stickel, MSN, RN, senior vice president and chief nursing officer. "We wanted to increase volume, improve quality of care within our core measures, and look at patient satisfaction — because any time you make changes, you do not want to adversely impact patient satisfaction."
The implementation phase was completed in December 2008, and it clearly has succeeded. In addition to boosting revenue and reducing the percentage of patients who leave before treatment, Stickel reports that core measures "are just about running at 100%." These include giving aspirin and beta-blockers to heart attack patients within 90 minutes, and blood cultures and antibiotics for pneumonia patients within four hours.
As wait times dropped, patient satisfaction scores climbed from the ninth percentile to higher than a 90th percentile ranking. "Our task force selected five questions for every patient to be asked," says Stickel, noting they included topics such as wait time, overall experience, and confidence and trust in their doctor.
The staff is able to keep track of their performance thanks to a dashboard developed with Compirion. "We have a weekly dashboard of our metrics, which shows us what the baselines were and what our targets are," Stickel explains. "We still look at them. We don't want to get complacent."
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