Since August 2011, the emergency department at Lake Cumberland Regional Hospital in Somerset, Ky., has put patients on a much faster track: Length of stay is down by more than 40 minutes; wait time for a physician is down from 48 to 12 minutes; the number of patients leaving before being seen (and against medical advice) is a fraction of 1%; volume has increased by 6%; and patient-satisfaction scores have hit an all-time high of 8.22 on a 10-point scale.
Plagued by inefficiencies and discouraged by past attempts to reform their processes that hadn't produced the desired results, the ED's nurses, physicians and staff gave it another try by using Lean management concepts and data analysis to zero in on needed process improvements. Solutions included sending patients immediately to a bed upon being registered, providing walkie-talkies to staff to improve communication and regularly monitoring department data.
Those efforts and results at the 242-bed acute-care facility also have resulted in it winning the 2012 Spirit of Excellence Award for Process Improvement. “We had historically struggled with trying to get our satisfaction scores up,” says Linda Hunter, senior director of emergency and ambulatory-care services. “The comments from patients were that we were too slow, they spent too much time and it took too long to be seen.”
But the ED hadn't been keeping track of average times until the initiative began, Hunter says. “The data was so valuable,” she says. “That's when we started seeing the progress, when we starting posting the data. It started a competition, a little bit, and it let (staff) know that we were watching, and that it was important.”
Lead charge nurse Sandy Russell says leaders started to build support by getting all charge nurses on board with the project, and they became team-builders. A 15-member multidisciplinary project team put together recommendations. Administrators visited on the floor daily for the first month to ask how things were going and to see what obstacles needed to be addressed—including human ones.
To ease the transition, the ED moved equipment, putting oxygen saturation at the bedside and mounting thermometers inside rooms instead of in hallways. They also installed electronic tracker screens that showed which patients needed to be seen and how long they had been waiting.
Nursing staff has since bought into the project, Hunter says, which has made further changes easier to sell. “Many of them said they thought direct bedding was a great improvement for the ER,” Hunter says. “Many of the same nurses who said they thought it wasn't going to work, now, when we bring new ideas into the project, they're a lot more likely to try it and embrace it.”
“Our patient-satisfaction scores are trending very well, currently, and times have been sustained throughout 2012,” Chief Nursing Officer Cheryl Glasscock says. “Sustainability is important in projects like this, and we've been so pleased that the process changes have become part of the culture.”