2009-11-02 17:27:04 -
IRVING, TX -- (Marketwire) -- 11/02/09 -- Rapid treatment in the emergency department is key for serious medical issues, and it's an overall driver for patient satisfaction, which is a new measuring stick for Medicare reimbursement.
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.
Since 2005, 28 hospitals in Oklahoma and Arkansas have worked together, through VHA Inc., the national health care network, to identify ways to improve ED throughput. Building an efficient ED system takes intense coordination across a hospital, meaning 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.
National ED wait times hover around 156 minutes, but some hospitals in Oklahoma and Arkansas have managed to treat patients in as little as 97 minutes. This means they can see more patients during a given 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.
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 to be seen, and leave before being treated. Each patient who leaves represents a loss of potential income for the organization, as much as $300 per patient.
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% to 3%. Eleven of the 28 participating hospitals have rates below the national average, and some Oklahoma and Arkansas hospitals have reached near zero for LWBS. All of this has occurred despite emergency room volumes that are on average 13% 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," said Bruce Naylor, M.D., vice president of clinical improvement for VHA's regional office in Oklahoma City, "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 health care across the nation."
One of the participating hospitals, Comanche County Memorial Hospital in Lawton, Okla., has experienced a 33% increase in ER volume since 2005. In the face of this marked increase in volume, the ED has decreased length of stay by almost an hour and dropped its LWBS rate by 6%, according to Randy Segler, chief executive officer of Comanche County. "That 6% 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. Our team is very proud of that improvement," said Segler.
Keys to Improving Services:
-- Utilize a visible, involved, experienced triage nurse
-- Train staff to use established triage protocols
-- Perform patient assessments separate from triage
-- Ensure that triage results drive bed or room placement for patients
-- Perform registration at the patient bedside
-- Ensure that physicians and nurses perform as teams
-- Implement patient tracking systems
-- Employ throughput-focused physicians in the ED
About VHA
VHA Inc., based in Irving, Texas, is a national network of not-for-profit health care organizations that work together to drive maximum savings in the supply chain arena, set new levels of clinical performance, and identify and implement best practices to improve operational efficiency and clinical outcomes. Formed in 1977, through its 17 regional offices, VHA serves more than 1,400 hospitals and more than 24,000 non-acute care providers nationwide.
BACKGROUND
Twenty-eight hospitals participate in the VHA Oklahoma/Arkansas Emergency Department Collaborative:
CITY STATE
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Arkansas Methodist Medical Center Paragould Ark.
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Baptist Health Medical Center North Little Rock Ark.
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Baptist Health Medical Center Arkadelphia Ark.
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Baptist Health Medical Center Little Rock Ark.
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Comanche County Memorial Hospital Lawton Okla.
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Conway Regional Medical Center Conway Ark.
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Duncan Regional Hospital Inc. Duncan Okla.
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Grady Memorial Hospital Chickasha Okla.
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Great Plains Regional Medical Center Elk City Okla.
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INTEGRIS Baptist Medical Center Oklahoma City Okla.
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INTEGRIS Baptist Regional Health Center Oklahoma City Okla.
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INTEGRIS Bass Baptist Health Center Enid Okla.
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INTEGRIS Grove General Hospital Grove Okla.
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INTEGRIS Southwest Medical Center Oklahoma City Okla.
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Jackson County Memorial Hospital Altus Okla.
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McAlester Regional Health Center McAlester Okla.
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Memorial Hospital of Texas County Guymon Okla.
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Moore Medical Center Moore Okla.
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Norman Regional Health System Norman Okla.
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Parkview Hospital El Reno Okla.
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Piggott Community Hospital Piggott Ark.
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St. Bernard’s Medical Center Jonesboro Ark.
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Stillwater Medical Center Stillwater Okla.
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Tahlequah City Hospital Tahlequah Okla.
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Unity Health Center Shawnee Okla.
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Valley View Regional Hospital Ada Okla.
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Washington Regional Medical Center Fayetteville Ark.
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White County Medical Center Searcy Ark.
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