No one likes to wait in line. Especially when severe illness or injury leads you to seek help at your local emergency department (ED), the last thing you want is to spend hours waiting for treatment.
In recent months, Sentara Martha Jefferson Hospital has been updating some of its ED processes—at both the main Pantops location and the standalone Proffit Road facility north of town—to help you get to see a doctor faster. These improvements are part of an effort across the entire Sentara Healthcare system, dating back to late 2015.
One major goal of streamlining procedures is to get “treat-and-release” patients (those who are released following treatment) in and out of the hospital within two hours. For “treat-and-admit” patients (those who are admitted to the hospital for further care), the target is to get them checked into their inpatient unit within four hours or less.
“Being able to get patients in and out quickly definitely makes people happier,” says Frank Jargowsky, director of patient care services at Sentara Martha Jefferson. “There’s also an operational benefit for the hospital—the faster we can get people through our system, the more patients we can help overall. Before we started this streamlining process, we measured ourselves against national metrics and saw some opportunities for improvement. Since then, we’ve been focused on providing faster service without compromising quality of care.”
While the process is continually evolving to incorporate best practices, the efforts thus far have shown positive results. Across both facilities, the current median time from arrival to seeing a physician is 18 minutes. And impressively, the Proffit Road ED currently has the best treat-and-release times in the Sentara Healthcare system, with 70 percent of patients released within two hours of arrival.
“We’re taking people back to a treatment bed very quickly,” Jargowsky says. “They need care, and now we can get it to them much more rapidly than before.”
Delivering faster service to patients starts with changes to ED operations. In the past, for example, patients were greeted by a triage nurse, whose duties included reviewing symptoms, identifying drug allergies and checking vitals such as blood pressure. Today, however, patients are met by a clinical greeter who registers them, gives them an armband and takes them to a bed. The triage process now takes place at the bedside—often with a nurse and doctor seeing the patient at the same time. That not only improves communication, but also speeds up next steps, such as getting X-rays or drawing blood samples.
“We try to do as many parallel processes as possible,” says Jeffrey Alberts, MD, of US Acute Care Solutions. “You can think of it like the line at the grocery store. You’ve got a bunch of different cash registers, but the customers aren’t all stuck in one line—everyone tends to choose the one with the shortest line. We’re trying to do something similar by eliminating inefficiencies and enabling as many parts of the caregiving process as possible to occur simultaneously.”
Efforts to move patients more quickly through the ED have involved collaboration with staff from all areas of the hospital. For example, Sentara Martha Jefferson hospitalists (physicians who care for patients in the hospital) have changed how orders are written to help speed the process of getting patients from the ED to the inpatient floors. They also have changed their morning rounding procedures to discharge patients as early as possible, making more beds available for ED patients.
“This is not an isolated ED problem to solve—it’s really about all parts of the hospital with which the ED interacts,” says Courtney Lambert, RN, ED nurse manager at the hospital. “Patients who come to the ED might go to Radiology for imaging tests, or they might have lab work done. If a patient is admitted, his or her bed on the inpatient floor has to be cleaned by Environmental Services first. So we really have to work together across all departments to determine how we can impact the patient’s flow through the ED most effectively.”
The ED’s fast-track area for less severe injuries and illnesses also has been reworked. Three beds in the ED are now designated for these patients, and a nurse practitioner or physician’s assistant staffs the area for 10 hours each day. Additionally, Sentara Martha Jefferson continues to offer InQuicker, which allows patients to register online and wait for an approximate treatment time from the comfort of home.
The entire ED staff has been involved in the implementation of the improvements through focus groups and limited trial runs of proposed changes.
“Anytime there is potential for improving a process, there is opportunity for growth,” Lambert says. “We’ve taken many of the changes in smaller chunks and implemented them carefully and incrementally, using feedback from the staff. We might take a six- to 12-hour interval of our day to try out a new process. If it works well, we can consider adopting the change as a more permanent solution. If it doesn’t work well, we can look back and discuss what we could do to improve the process and then try again.”
To help ensure that ED process changes don’t have any negative impacts on care, the department is closely watching patient satisfaction scores.
“We continue to live by the principles of the Caring Tradition,” Jargowsky adds. “Through the streamlining, we’re simply trying to make the whole process smoother and more pleasant for our ED patients, while maintaining the safe, high-quality, compassionate care for which Sentara Martha Jefferson is known.”