Backus ED ranks in top 3% nationwide
Dr. Sidman |
Jennifer Cooper, RN treats patient Joseph R. Portelance, Jr. in the Backus Emergency Department. |
In emergency medicine, nearly everything can be measured. Patient volume by time of day, and day of week. Number of lab tests or radiology exams ordered. The time it takes to be seen by a doctor.
But there is one statistic that matters more than most: What the patients say. At Backus, they're saying, "Well done."
Backus Hospital's Emergency Department ranks among the top 3% of hospitals nationwide in terms of patient satisfaction. That's the finding of the latest patient satisfaction report, based on the responses of ED patients from the beginning of February through the end of July. It compares Backus patients' ratings against 395 hospitals throughout the country that see 40,000 or more visits per year.
"This isn't just a number. This is a report of patient perception, and that is what really matters," said Robert Sidman, MD, Chief of Emergency Services. As the door to the hospital for many, the patient experience in the ED has a powerful influence on the community's perception of the care a hospital provides.
Dr. Sidman is quick to note that continual gains in ED satisfaction scores over the past two years are the result of a true team effort. It takes several departments working in concert to ensure an optimal experience for an emergency patient: registration, laboratory, radiology, respiratory therapy, security, volunteer services, environmental services, nursing units, psych services and physicians, among others. Externally, good coordination with the Emergency Medical Services community also plays a key role.
"Achieving this level of performance is a celebration of teamwork," said Mark Santamaria, Senior Vice President and Chief Operating Officer. "This is an outstanding example of how people can work together to tackle a series of complex issues. Lots of people had a role in this, and everyone should feel proud."
The improvement process began about two years ago, by repeatedly asking two questions: What are the barriers to getting things done? And, what can we do to overcome them?
Then, some guiding principles were used.
"Include staff in the process," explained Mr. Santamaria. "Make systems easier. Use parallel processes rather than serial processes. Involve other departments in the solution to reduce turn-around times. Take a hard look at policies, and revise them whenever it makes sense."
The results of this improvement process created an ED that is more efficient, more patient-focused, and more flexible. For instance, Convenient Care (where patients with less emergent issues, such as a minor sprain or an earache, would be seen) accounted for 26% of total ED volume in 2005. Today, with changes in hours of operation, staffing, triage protocols and a new location it sees 42% of ED patients - in less time. Average length of stay in Convenient Care is down to 90 minutes. This also allows the main ED to focus on the most ill and injured.
It's worth noting that the ED patient satisfaction gains came during a time of disruption and dislocation in the ED, Convenient Care, Same Day and PACU areas, due to the hospital's expansion project.
"People appreciate a brand new facility - one that's brighter, thoughtfully designed with amenities like TVs and phones," Dr. Sidman said. "But they pay attention to care even more. Patients really notice when processes are working to get them the care they need."
That's apparent in patients' responses to individual questions. For instance, Backus ranks in the top 1% nationwide on comfort of the waiting area - and also in the top 2% on being informed about delays and overall rating of emergency care.
Dr. Sidman credits several process improvements with increased patient satisfaction:
- The fine-tuning of "standing orders." These medical protocols for common issues allow nurses to perform tests and begin treatment based on presenting conditions. For example, a seven-step routine for many patients who complain of chest pain begins with an electrocardiogram and ends with a chest X-ray, with appropriate meds and monitoring in between. The newly updated ED Intranet contains a ready guide of 21 such standing orders.
- Bedside registration: Delays can be reduced by making a request for an inpatient bed as soon as it is likely an ED patient will require hospitalization. If inpatient census allows, this early communication can get patients onto an inpatient unit faster. Waiting in the ED after being told you're being admitted is a major complaint in emergency rooms nationwide.
- Making data your friend. Measure everything that matters. By gathering and studying data on wait times, or what causes delays, processes can be improved - and those improvements can be measured. Here's one success story: The percentage of patients who leave the ED before their evaluation is complete fell under 1% in July. This benchmark had been as high as 7% nearly two years ago. The target national benchmark for having patients leave before complete evaluation is between 2% and 2.5%. July, by the way, was also the business month ever for the ED, with 5,098 visits.
"The ED is one of the most stressful places for any staff member to work, but it can also be incredibly fulfilling," Dr. Sidman said. "By using processes to focus on real patient issues, we are able to meet and exceed expectations. That's what it's all about."