Saint Vincent Hospital’s emergency department sees over 60,000 patients annually in its 38-bed facility. With approximately 165 patient visits every day, the emergency department was struggling with ‘door to doctor’ times as high as 80 minutes and ‘left without being seen’ rates as high as 8%. Leadership was determined to increase operational efficiency and quality metrics throughout the ED.
The HMFP-led team consisting of physicians, nurses, administrators, and technicians was supported by corporate and hospital administration on the goal of designing programs that would reduce metrics such as ‘door to doctor time’ and ‘left without being seen rate.’ We implemented a series of changes to dramatically improve operational efficiency such as:
- A flexible staffing model that allocated appropriate staffing levels based on hourly, daily, and seasonal ED demand;
- A split flow model that rapidly identified less acutely ill patients and prepare these patients for a quicker discharge, ultimately decreasing ‘door to provider time;’
- A lean process methodology that allowed the ED to fast track patients, cycle beds more quickly, and staff the ED more efficiently.
- The ‘left without being seen rate,’ once as high as 8%, has been reduced to below 1%;
- The average ‘door to doctor’ time has been cut by 60%, to less than 30 minutes;
- The average time to ECG has been cut by 60%, to less than 5 minutes;
- In 2011, 86.8% of patients seen for stroke care received defect-free care (ranked 3rd out of 17 SCORE large volume Massachusetts hospitals);
- Troponin time reduced by 40% using process improvements;
- Total ED volume has increased every year since 2008, currently averaging 174 patient visits per day.