Posted by Brigham and Women's Hospital June 27, 2012
No one looks forward to visiting the emergency department. That’s why it’s important to make such visits as safe, effective, and efficient as possible.
Ongoing review by Brigham and Women’s Hospital (BWH) Emergency Department (ED) leadership in 2009 determined that although medical outcomes for their patients were consistently excellent, there was still room to improve patient care. ED leadership immediately set out to make things better – focusing on getting patients the right care as quickly as possible, eliminating waste, and improving teamwork.
Within three years of beginning facility and process improvements, wait times and length of stay have dropped dramatically. The median wait time for a patient to reach a bed has decreased from more than one hour to less than 15 minutes, nearly half of all patients are in a bed within 10 minutes, and the average total length of stay has decreased by more than one hour, despite a six percent increase in the number of patients visiting our ED. And along with these care improvements has come a dramatic increase in patient satisfaction, lifting the department to the 99th percentile nationally.
These results were the product of a modest expansion of patient care space – largely by converting waiting room space into a new clinical unit – and, most importantly, a complete operational redesign, resulting in a new emergency care process. The new model focuses on getting patients directly to care, and with units in the ED emphasizing the need to create capacity to accept new patients, a “direct-to-provider” model is used whenever possible. Arriving patients are met by a registered nurse greeter and asked a short series of key questions. Patients are then assigned to a provider team and brought directly into the patient care area, instead of back to a waiting area or into a prolonged triage process.
Throughout their ED visit, patients are cared for by the same team of clinicians – nurses, physicians, physician assistants, and residents – continuously working together. This team focus helps ensure that providers and staff are thoroughly familiar with the patient’s condition at every step of care, which enhances efficiency, communication, and safety. The team also encourages family or other support persons to accompany the patient throughout the emergency care process to provide comfort, to help answer questions, and to be informed regarding their loved one’s condition.
Although the data overwhelmingly supports the notion that this new process is an outstanding success story, the ED team continues to seek ways to further improve patient care. As Clinical Director Dr. Josh Kosowsky explains, “With our remarkable staff, we truly believe anything is possible.”
– Chris P