Hospitals in Oklahoma, Arkansas boost ED efficiency

By Bernie Monegain
10:09 AM
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Twenty-eight hospitals in Arkansas and Oklahoma have lowered wait times in their emergency departments by working with VHA, Inc., a nationwide healthcare network.

One key to their improved efficiency: a patient-tracking system.

Rapid treatment in the emergency department is key for serious medical issues and an overall driver for patient satisfaction, which is a new measuring stick for Medicare reimbursement, VHA officials note. However, it's becoming more difficult to accomplish this goal due to rising ED volumes, driven by the poor economy and the influx of patients due to the flu season.

Building an efficient ED system takes coordination across a hospital – patient assessments must be correct, lab tests must be performed in an accurate and timely manner and imaging and surgical resources must not be bottlenecked, according to VHA.

Based in Irving, Texas, VHA is a national network of 1,400 not-for-profit healthcare organizations that work together to drive maximum savings in the supply chain arena, as well as set new levels of clinical performance.

Since 2005, the Arkansas and Oklahoma hospitals have worked together to identify ways to improve ED throughput.

National ED wait times hover around 156 minutes, but some hospitals in Oklahoma and Arkansas have managed to treat patients in 97 minutes. This means they can see more patients during a 24-hour period, which is crucial to hospital finances since the ED is a dominant source of hospital admissions and it drives revenue through the use of lab, surgical, imaging and ancillary services, said Bruce Naylor, MD, vice president of clinical improvement for VHA's regional office in Oklahoma City.

Another measure of ED efficiency is the percentage of patients who "leave without being seen," commonly referred to in the industry as the LWBS rate. This measure reflects the number of patients who get tired of waiting  and leave before being treated. Each patient who leaves represents a loss of potential income for the organization – as much as $300 per patient, Naylor said. Using that metric, seeing an additional 5,000 patients annually in the ED would generate an additional $1.5 million in net revenue.

The national LWBS average is around 2 percent to 3 percent, according to VHA. Eleven of the 28 participating hospitals have rates below the national average, and some of those hospitals have nearly eliminated LWBS.

All of this has occurred despite emergency room volumes that are on average 13 percent higher than 2005 levels at the participating hospitals.

"We've tracked steady improvement across many ED measures for the participating hospitals, compared to national standards," Naylor said, "but the real driver for improvement for these hospitals is not comparing themselves to national standards, but with each other. Once a hospital administrator sees that another hospital has achieved success, he or she picks up the phone and asks how. That's the power of VHA. It's hardwired into our members to connect with one another. We open doors for the sharing of best practices and tools that support improvement. That's going to be the key to improving healthcare across the nation."

One of the participating hospitals, Comanche County Memorial Hospital in Lawton, Okla., has experienced a 33 percent increase in ER volume since 2005, yet the ED has decreased its length of stay by almost an hour and dropped its LWBS rate by 6 percent, according to Randy Segler, CEO.

"That 6 percent decrease in LWBS rate means that our ED is now seeing about 3,000 more patients per year, patients who previously left before care could be provided. Now they are being seen in a timely manner and given the care they need," Segler said.

To improve ED services, VHA recommends:

  • Implementing patient tracking systems;
  • Using a visible, involved, experienced triage nurse;
  • Training staff to use established triage protocols;
  • Performing patient assessments separate from triage;
  • Ensuring that triage results drive bed or room placement for patients;
  • Regisering at the patient's bedside;
  • Ensuring that physicians and nurses perform as teams; and
  • Employing throughput-focused physicians in the ED.