In two years, Parma (Ohio) Community General Hospital's emergency department cut diversion hours by 33%, the average length of stay for treat-and-release patients by 39%, and the number of patients leaving without being seen by 52%. Patient-satisfaction scores have risen from the 21st percentile to the 83rd percentile on the Press Ganey Associates survey.
To bring about these results, Parma developed multidisciplinary Healthcare Excellence Through Action Teams (HEAT), which have earned the 346-bed facility an honorable mention in the Spirit of Excellence Award for Quality.
Based on feedback from a hospitalwide brainstorming process, Parma recast "patient holds" as "Parma holds" because bottlenecks in critical-care areas often were part of the problem. "The emergency department had the symptom, but it wasn't the cause," Chief Executive Officer Patricia Ruflin says. "If you make it a `Parma hold' the person who manages the critical-care area has just as much responsibility."
To enforce that notion, nurse managers sign written agreements to hold beds open, and a clinical supervisor for admitting floats between floors to maintain momentum. Within the department, a new computer system helps staff quickly see which patients have waited too long. As a result, the average length of stay for treat-and-release patients has decreased from 4.1 hours to 2.5 hours.
"A manager can come in ... and within 10 minutes know exactly what's going on in the department and address those problems," says Bob Barberio, director of management engineering.