Healthcare News & Insights

Reduce ED overcrowding: One facility’s success story

Overcrowding in the emergency department isn’t a problem that’s easily solved. However, one hospital managed to do a complete transformation of its ED, turning it from one of the most chaotic areas of the facility to a smoothly running machine. 

ThinkstockPhotos-538726573The University of Colorado School of Medicine and Hospital had several big issues with its ED, as described in an article from Harvard Business Review by Dr. Richard Zane, the hospital’s chair.

Back in 2012, the facility’s emergency department was so crowded, patients frequently left without being treated and went to other nearby hospitals. Staff often referred patients to other facilities.

Ambulance diversion was also a regular occurrence. The hospital had to turn ambulances away for at least eight of every 24 hours – and usually for longer. In fact, it was so bad that other area hospitals would place bets on how long it would take the facility to start diverting ambulances again once the restriction was lifted.

Not surprisingly, the overcrowding and wait times caused patients to complain. There were also issues with health code violations. Because of all these problems, the Colorado Department of Health started visiting the hospital on a regular basis to investigate its care.

That’s when the facility knew it needed to make a change.

False start

At first, it tried expanding, thinking that having a larger ED would be the best bet. However, the larger ED ended up having fewer areas for patient treatment than the old, smaller one did.

So the hospital had to go back to the drawing board, and it decided to focus more on its care delivery process than the interior layout for the ED.

The first major change was one involving leadership. The hospital created a senior leadership committee with eight high-ranking executives, including Dr. Zane, and it identified three critical areas the hospital needed to focus on to improve care:

  • quality
  • operations, and
  • process improvement.

Subcommittees were created to delve into each individual area, with members occasionally rotating from one committee to another so they could share ideas and insights.

6 keys to success

The hospital’s transformation process was guided by six principles:

  1. Put patients at the center. Improving patient care was the driving force behind every decision. If a committee member couldn’t say how changes would benefit patients, they weren’t considered at all.
  2. Use data relentlessly. Every action that affected patients was tracked and measured, whether it was through the electronic health records (EHR) system or manually with a stopwatch. Results were released regularly, and any problems were corrected immediately.
  3. Speak with one voice. Although all viewpoints were considered before making a decision, once a decision was made, everyone endorsed and enforced it equally. Any failures were publicly acknowledged, and everyone worked together to fix them.
  4. Value everyone’s perspective. Execs listened to feedback from staff at all levels, from providers to respiratory therapists and housekeepers. Many of their ideas were implemented to improve efficiency. This made everyone more invested in the care process, which got them on board with changes faster.
  5. Deliver high-quality care universally. The team helped develop standardized care protocols for the conditions that posed the highest risk to patients, such as sepsis, heart attack, stroke and major trauma. All patients with signs of these conditions were treated using the same uniform procedures, which has been beneficial for their quality of care.
  6. Set the standard. When implementing each new procedure, the hospital wants its results to be seen as the gold standard for all hospitals to follow. It’s a high bar to set, but it’s paying off.

Proven results

In the first three years of its transformation, the hospital’s seen some big changes. ED volume has increased by 53%, but the total treatment time for patients has been cut by 40%. Patients only wait an average of about eight minutes to see a doctor.

And instead of referring patients to other EDs, almost every patient who enters the ED is treated. Ambulance diversion, a way of life for the facility before, is now a thing of the past.

The University of Colorado School of Medicine and Hospital’s story is an example of how any facility can bounce back and transform its care processes.

A culture of openness and transparency has been vital to its success, and other hospitals can take a page from its book if they’re looking to make serious improvements.

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