The Medical Center of Central Georgia expects to increase its revenues by $20 - $24 million this year, after an improvement project along the entire Emergency Service Line, including related inpatient departments that began in June 2008. Since the project, the hospital has consistently grown its billable patient volume through the Emergency Department by 15% in month-to-month comparisons with last year. Compirion Healthcare Solutions, a healthcare process improvement firm based in Elm Grove, Wisconsin had been engaged by hospital management to assist in the process.
Compirion was selected upon referral by another regional medical center located in nearby Columbus. Medical Center of Central Georgia management liked that Compirion worked on site, full time, hand-in-hand with hospital staff, rotating through all shifts, and that Compirion guaranteed agreed upon goals would be met. Goals included: reduced overall length of stay by 50%; increased billable volume from 132 to 150 patients per day and elimination of diversion hours.
Over 14% of patients at the Medical Center Emergency Department left without being seen (LWBS). This is almost triple the national standard and was responsible for a significant loss in hospital revenue. The goal for this metric was set at a maximum of 3.5%.
Barb Stickel, Chief Nursing Officer commented, "Emergency Department throughput was way higher than the national benchmark. It was more like a holding center than an Emergency Department. We were not fully staffed and we were over capacity. We tried to fix things ourselves but the staff became discouraged, they wanted help."
In June 2008, a Compirion team of three consultants arrived on site and began observing staff behavior and the day-to-day processes in the Emergency Department. After review, the Compirion team worked together with senior level management and hospital staff to set performance goals, identify pilot initiatives and to build Core Teams around these initiatives.
Dr. DeLanor Doyle, an Emergency Department physician during the time of the project, commented, "We realized we had to change our core processes. Triage became 'triage and treatment,' all in the front of the Emergency Department. We utilized unused areas as treatment areas. With a lot more happening, during high traffic times, it is almost like controlled chaos... but patients can appreciate that we are trying to see them."
By analyzing the shift data over a one-month period, personnel were rescheduled around peak hours, which also alleviated wait times. A by-product of the rescheduling was an increase in labor productivity. The shorter length of stay had the effect of reducing the number of patients who left without being seen (LWBS) to 2.72% by the end of the improvement project."
The chest pain center, which was originally on another floor, was moved into the Fast Track area closer to the emergency department so that chest pain specialists could assist in the Emergency Department in case of a crisis. In this way, they improved ED physician productivity and eliminated the need for hiring more physicians.
As a result of improved throughput, billable patient volume grew from 132 to 151 patients per day. To handle the increase in the Emergency Department, more beds on the floors needed to be available during peak hours. Hospital staff from the inpatient units pitched in to help the Emergency Department. They implemented several processes including a process they named Code Consensus. During a Code Consensus, a signal or code is delivered throughout the facility to expedite patient discharge, housekeeping and bed availability.
Stickel added, "The current code is the theme to the Lone Ranger. The first time we played it, we opened up 20 - 25 beds in the first two hours."
By the end of Compirion's engagement in January, the elapsed time from patient registration to inpatient units had dropped by 50%. The goal for door-to-treatment time for outpatients had been set at 4.5 hours. In January, the hours dropped from 6.65 to around 4 hours, well below the hospital's target. As wait times dropped, patient satisfaction scores climbed from the 9th percentile to over 90th percentile ranking. Physician satisfaction scores also climbed to the 90th percentile. For an investment of less than $500 thousand dollars, the improvements made to length of stay, patient satisfaction, labor productivity and the percentage of patients who left without being seen (LWBS) have generated a return of 40:1.
According to Doyle, "Revenues went through the roof making Administration very happy! And, things continue to improve. We are currently two million dollars more to the positive this month vs. the same month this quarter last year. We expect to finish $20 - $24 million more this year over last. I'd say we got our money's worth."
Stickel remarked, "This was one of the most positive processes I have participated in and I have worked with a lot of consulting firms. We can now handle 208 visits with few walkouts. The dashboard they provided is a constant monitor of our success on a daily basis."
Doyle, now Medical Director of the Emergency Center concluded, "Compirion was very hands on. They identified the problems and made us design our own processes to solve them. They watched and measured and kept raising the bar. It's a good system and great to see the Medical Center decide to take ownership of it. We keep tweaking... that's what it is all about."
Compirion Healthcare Solutions, LLC is based in Elm Grove, Wisconsin. Compirion is a leader in healthcare consulting firms focusing on whole hospital process improvement. They work on site using a team approach and offer a money back guarantee that all goals are completed. Client hospitals show sustainable performance improvements in billable volume, patient satisfaction, core measures, length of stay, bed control, case management and staff retention. Their experience includes emergency room, surgical services, outpatient and inpatient nursing care improvement projects. They contract only for measurable outcomes to help achieve patient satisfaction, staff loyalty and a better bottom line.
For more information on Compirion's sustainable healthcare solutions call 1-866-661-4677, or visit http://www.compirion.com/macon
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