ED Patient Flow & Waiting Time

Mary Washington Health System is a sole community provider that provides an array of health services from obstetrics to cardiovascular care in a very fast growing community, 50 miles south of Washington DC.

Challenge

In 2004, Mary Washington Health System had an extremely busy Emergency Department with over 75,000 visits per year and growing each year (today over 90,000). They were fraught with a number of process issues. Patients were facing 11+ hour wait times. The walk out rate was as high as 10%. There was a shortage of inpatient beds. The ED and hospital had a poor image in the community. Not surprising, patient satisfaction scores were very low. In addition, 68% of all its admissions came from the Emergency Department. The Emergency Department was the life line to support the growing community's healthcare needs.

Process

Patient Flow Excellence Accountability Teams (PFEAT) were formed under the direct oversight of hospital executives. These teams took a holistic approach and included teams from ED, Scheduling/Admitting, Physicians, Facilities, Housekeeping, Lab, Radiology, etc. It was recognized that the back up in the Emergency Department was not solely dependent on its processes and performance but multiple departments working in concert.

Solution

PFEAT recommendations included process changes, new technology, new capacity and role changes. The ED installed point of care lab testing and a virtual bed tracking system. Admitting/discharge nurses were created for each nursing unit, to facilitate on-time discharges. Mary Washington Health System also added 100 beds to its capacity. It should be noted that several initiatives such as a discharge lounge and early discharges were implemented and did not work. Finally, a Patient Flow Management Dashboard was created manually to support these initiatives and capacity alert plan. Mediware's InSight™ was brought in as the tool to automate the entire PFEAT solution, including many previously manual dashboards. InSight™ helped to improve incorrect and inconsistent data, thereby increasing confidence in the reported results. InSight™ also provided daily access and visibility to these vital measures for all teams members.

Result

ED patient wait times decreased 45%. ED walkout rate dropped 60%. Inpatient average length of stay dropped by .5 days. Patient satisfaction scores soared. Mediware's InSight™'s use has expanded to 289 measures and nearly 150 users.