In 2009, the 18-bed emergency department (ED) at Medical Center of Lewisville (MCL) was underperforming on nearly every standard.
The average time of ED from patient arrival to discharge exceeded 200 minutes. The ED was clogged. Hall beds were a daily occurrence. Patient satisfaction and staff morale were low.
In 2010, the HCA’s hospital leadership established a goal of reducing turnaround time by about one-third to 130 minutes or less. The facility recruited a multi-disciplinary team to tackle the problem. There were a number of innovative changes:
- Roving admission nurses hastened patient admissions and discharges.
- A “bed czar” managed the admission nurses and oversaw bed control.
- Rooms were cleaned and prepared for new patients within an hour.
- Physicians began seeing ready-to-discharge patients at the beginning of rounds rather than at the end.
- A dedicated ED lab technician focused on hastening test results.
- If an admitted patient was not in a bed after 60 minutes, the ED charge nurse called an administrator to trouble-shoot the situation.
The metrics have improved in nearly every area:
- The ED hit its goal of less than 130 minutes within seven months and has maintained it ever since. MCL has led the HCA North Texas Division in meeting or exceeding ED throughput goals for the last 29 months and is ranked in the top 10 within HCA nationwide for high-performing EDs.
- The ED lab results turnaround time was cut from 53 minutes to 21 minutes.
- The time from arrived to seeing a physician decreased from 41 minutes to 12 minutes.
- ED volume has increased by 22 percent because of the improved throughput.
- Patient satisfaction rose from 47 percent to 70 percent.
- The percentage of patients leaving without seeing a physician has fallen to below 1 percent, compared with the national average of 3-5 percent.
Last month, MCL was awarded the 2012 Texas Hospital Association’s (THA) Bill Aston Award for Quality in the Non-Research/Non-Teaching Hospital/Health Care System category.
In a statement, THA president and chief executive officer Dan Stultz said, “Medical Center of Lewisville has demonstrated a long-standing commitment to improve the health of every member of their community by providing timely and efficient operations that result in increases in patient satisfaction. Their leadership in this area shows keen insight for where health care is headed in the future, and we applaud their effort.”
Michelle Underwood, who oversaw the MCL ED at the time and now is assistant vice president for free-standing ED operations for HCA North Texas, said the key to the facility’s success was that “every hospital employee was committed to improving the ED. It just wasn’t an ED problem. (The ED problems) impacted all of us.”
Underwood said the permission to call administrators when there was a bottleneck was instrumental in the effort.
“I never met a CEO who was willing to get a call at 2 a.m. Nobody wants to make that call,” she said.
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at firstname.lastname@example.org.