How Sacramento’s Busiest ED Doubled Capacity Without Expansion

Emergency SignThe emergency department (ED) at the Kaiser Permanente South Sacramento Medical Center, one of California’s busiest EDs, has cut patient turnaround times by hours and to far below the national average, through operations improvement, according to Healthcare Informatics. This Level II trauma center saw its workload almost double from 2008 to over 120,000 annual patient visits by 2015. The existing ED space was constrained with only 49 ED bays of which three are dedicated for trauma and four are dedicated to psychiatry. This calculates to 2,500 annual patients per ED bay compared to a recommended 1,500 to 1,800 for a well performing ED. The increasing patient volume and space constraints resulted in long ED wait times with patients waiting five to six hours to see a doctor and every night there were 30 to 40 patients in the waiting room.

After an intensive operations improvement effort using “lean” production principles, South Sacramento Medical Center’s average wait time in the ED was reduced to 19 minutes, less than half the national average of 58 minutes. The average length of stay (LOS) in the ED was reduced to 43 minutes for low-acuity patients compared to a national average of 118 minutes. The LOS for discharged patients was decreased from 4.5 hours to about 2 hours and the LOS for admitted patients dropped from 8 to 6 hours. According to Karen Murrell, M.D., the chair of emergency medicine at Kaiser Permanente Northern California, “Decreasing the length of stay creates capacity, so if we have a patient in a bed for two hours rather than four hours, we can see twice as many patients.”

Source: “How Eliminating Waste and Opening Data Helped Kaiser South Sacramento Create a “No Wait” ER” by Heather Landi, October 23, 2015 [Retrieved online at www.healthcare-informatics.com]

This article is an update of a previous post.

Hospital Emergency Departments Are Focusing on Seniors

Many hospital emergency departments (EDs) have specialty areas for children. Now some are developing separate areas for seniors with geriatric team-based care, more comfort, and less noise and confusion. The focus of the specialized team is to not just treat the immediate problem, but to uncover underlying problems ― from depression to dementia to a hazard-prone home environment. Seniors already account for more than million ED visits a year and by 2030, 20 percent of all Americans will be 65 or older. Older adults have different needs which are often at odds with modern EDs that are best equipped to handle crises like gunshot wounds or car crashes. Geriatric patients often need lengthy detective work to unravel the multiple ailments that they tend to show up with and may exhibit different symptoms than younger people. Their illnesses may cause confusion that can be mistaken for dementia. At the same time, cognitive problems may not be obvious when these patients are describing their symptoms or the onset of their medical problem. Seniors also have a high rate of recurrent visits to the ED.

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Case Study: Evaluating Emergency Expansion

Midwest Hospital planned to expand and potentially replace its ED in response to increased crowding and congestion. Although the current number of annual visits (40,000) was not expected to grow significantly in the near future, the patient and visitor waiting room was frequently overflowing during the evening hours. ED staff also began creating “hall beds” by labeling and assigning defined stretcher bays in the hallways to gain additional treatment space during peak periods. The relocation of an adjacent occupational medicine clinic was viewed as an option for ED expansion in lieu of total ED replacement.

Specific facility expansion goals included expanding the patient and visitor waiting space with enhanced amenities; providing adequate exam and treatment space; triaging nonurgent patients in a separate, fast-track area; and developing a holding area for patients to be admitted who are waiting for an available inpatient bed. Although facility expansion and operations improvement were deemed necessary by all members of the planning team, the CFO was concerned about spending significant capital dollars when ED revenues were relatively flat. ED staff were also not in agreement regarding the extent of required expansion; some wanted to almost double the size of the current ED, while others were concerned that significant expansion would require additional staff at a time when budgets were tight and recruiting was difficult. Others were concerned about the long ED length of stay and its impact on customer satisfaction. However, all members of the planning team agreed that a detailed analysis of the relationship between improvements in exam and treatment room turnaround time and resulting space need and construction cost was warranted prior to initiating the detailed operational and space programming process.

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Healthcare Organizations Using RFID in the Emergency Department

Patient Arm With RFID BandMost busy emergency departments (EDs) share the same goals of improving patient flow, shortening the length of stay until the patient is admitted or discharged, and reducing the number of patients who leave the ED without being treated. Healthcare organizations, including Christiana Care Health System in Wilmington, Delaware, are tackling all these problems using data from radio frequency identification (RFID) enabled real-time locating systems or RTLS. When patients arrive at one of Christiana Care’s two EDs, they are pinned with an RFID badge that tracks their movement. With real-time tracking, interval data can be measured — such as the time between a patient’s arrival to the time the doctor orders an x-ray, or to the time that the results are available or when the patient is discharged. Each of these separate data elements is fed into a central database that is integrated with data from other systems in the hospital including the computerized physician order entry (CPOE), laboratory, and radiology systems. The tracking data is then used to redesign operational processes to eliminate bottlenecks and improve patient flow.

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Hospital System Puts ED Wait Times on Billboards and the Internet

Akron General Health System recently began advertising real-time emergency department (ED) wait times on six digital billboards in Akron, Ohio that are automatically updated every 20 minutes. The billboards show current average wait times at the main ED in downtown Akron and in satellite facilities in the Montrose area, Stow, and Lodi. The times are computer generated based on current patient information from the health system’s electronic medical records. This information is also available to potential patients on Akron General’s website. Summa Health System — an Akron-based competitor — is developing a plan to share updated ED wait times and other information via mobile devices.

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Hospitals Ease ED Crowding With Hall Beds

Patient Bed in HallwayEven though hospitals have been trying for decades to eliminate the practice of temporarily parking patients on stretchers in corridors, a recent study at Stony Brook University Medical Center in Stony Brook, New York, found that no harm was caused by moving emergency patients to upper-floor nursing unit hallways when they were ready for admission. It may not sound like the ideal healthcare setting, but the study’s lead author is urging hospital officials nationwide to consider hallway medicine as a way to ease emergency department crowding.

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