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Educating the public, keeping customers informed, and enlisting volunteers to serve as patient liaisons and advocates are the three main components of an ambitious campaign by Baptist Memorial Health Care in Memphis that aims to reduce emergency department (ED) overcrowding.
"Basically, ED overcrowding is a national crisis, and we’re trying to do something about it," says Chuck McGlasson, RN, MSA, director of emergency services and pediatrics for Baptist Memorial Hospital-Memphis. A Tennessee Hospital Association study released in December 2002 found that ED visits in the state had increased 31% over three years, or twice the national rate.
Although Baptist Memorial officially launched its campaign in November, preparations had been under way for the past two years, McGlasson notes. During that time, he says, the health system pulled itself from the depths of ED patient satisfaction scores — "something around the 15th percentile" — to a recent rating above the 85th percentile. "Keeping the patient and the family informed is one of the main satisfiers," he says. That means answering the questions, "When will the doctor see me, when will the X-rays be back?" and, most important, "When am I going to be out of the waiting room and back in the treatment area?"
Patient communication, McGlasson adds, "means ensuring that patients in the ED understand what is going on with their visit from the time they present until the time they’re discharged." To address that core issue, he says, Baptist Memorial has made significant changes in its ED operation, including implementing fast-track registration and adding personnel during its busiest hours. "Instead of patients just seeing a triage nurse when they present, we now have two registered nurses and a paramedic during our peak times of 5 p.m. to 1 a.m.," he says. "We’ve added these extra people to check on patients and keep them informed.
"The paramedic, for example, is out in the waiting room, following up with patients and checking to see if their condition changes," McGlasson notes. "[The paramedic] can draw blood, do EKGs, and go out there and keep the patient informed." Part of the communication effort, he explains, focuses on letting patients know how the ED works. "A lot of people think it’s first come, first served. They don’t realize it’s about [who needs] urgent and emergent care."
Instituting the fast track program in February 2002 helped boost patient satisfaction scores by reducing wait times, McGlasson says. "We feel like running a successful ED means having a successful fast track." With 20%-25% of patients — those who might normally be treated in what Baptist Memorial calls "minor med" facilities — directed to the completely separate fast-track area, he adds, ED patients "are able to get seen pretty quickly."
The hospital’s ED registration process, McGlasson notes, is done entirely at bedside. "When patients come in, they talk to an emergency medical technician or a unit coordinator at the front desk, give their name and chief complaint, and immediately go to triage." Once the patient is in a room, he adds, "registrars go in and catch up at that point. We don’t do front-end registration."
To help explain such things as ED processes and how staffing works, among other topics, Baptist Memorial has created a magazine to be distributed in the waiting area, McGlasson says. The public education piece of the campaign, he explains, has to do with addressing national ED issues, such as defining urgent vs. emergent care and emphasizing other care options, such as the physician’s office or a minor med clinic. General tips are offered, including the suggestion to get a flu shot, he adds. "Having the flu really contributes to the winter [ED crowding] crisis."
To get these messages across, McGlasson says, "We’ve got billboards up in our area, ads in the newspaper, and some television commercials in the works."
Response has been positive, he notes. "Several people wrote letters to the newspaper saying how glad they were that we were doing this campaign." Comments centered on the importance of addressing the issue of ED use by those who are not seriously ill, he adds.
Volunteering in the ED
Perhaps the most innovative facet of Baptist Memorial’s campaign is the creation of a volunteer ED corps, called "Experience Critical," for the health system’s three metro EDs. In a divergence from the more typical senior citizen volunteer, McGlasson explains, the health system will launch a recruitment campaign targeting college-age students looking to enter the health care profession. The idea, he adds, is to find young people who "want to get in, see what’s going on, and be able to interact with patients, family members, and friends."
Training will be provided, he says. "We’re in the process of defining their duties. They won’t be hands-on, but will be keeping people updated, running errands, keeping families informed — all kinds of things."
Fueling Baptist Memorial’s efforts, McGlasson notes, has been its affiliation since October 2002 with "IMPACT," the "action network" of a national not-for-profit organization called the Institute for Healthcare Improvement (www.ihi.org). "It’s a nationwide initiative," he says. "You get to network with hospitals all over the country. We have a listserv where people who are doing the same things you’re doing can answer your questions. It’s a pretty good community of experts."
One of the IHI focuses, McGlasson adds, "is to look at flow across the continuum, from the time the patient comes in to the time they leave, whether they are discharged [from the ED] or they go to the floor."
[Editor’s note: More information on Baptist Memorial’s ED campaign is available at the health system’s web site, www.bmhcc.org.]