While many of the staff got behind the new order and genuinely tried to do the right thing, some were still resisting change. Consistency had been the primary challenge. The ED would have many days in a row with good to excellent performance, with a couple of bad days each week that brought the overall numbers down. Inconsistent staffing appeared to occur on these days, often with agency or PRN staff not accustomed to working together or familiar with the ED's processes. This is an area where the Flow Event significantly helped the staff understand that the focus of the department would be on the patient. Once implemented department-wide, the Flow Event created greater consistency between shifts and days of the week. ED leadership reinforced daily rounding with the staff to provide service recovery, as needed, and gave immediate feedback on performance. The senior management team began weekly rounding in the department. The entire staff received a clear message that their work is important and they began performing to higher standards.
Improvements in patient flow created an environment where staff attitudes became more positive. Their motivation improved as hospital personnel began to believe things could really change. Some of the Charge Nurses stepped forward and displayed strong leadership skills. They did the necessary follow-through to embed the changes in the department.
"We really put a lot of responsibility on the Charge Nurses," said Williams. "They were key because they are on the front line on a daily basis. They are checking on every patient, every thirty minutes. We started an in-house patient satisfaction survey. The Charge Nurses are in-charge of the surveys. They are also in-charge of callbacks. They call certain DRGs and make sure they received instructions, medications and that they answer any questions the patient has. They have done a great job."
Patients began experiencing a more polished, professional and caring staff after implementing the regimen of in-house patient satisfaction surveys, service recovery and 100% callbacks to patients after treatment within 24 hours of discharge. Patient Satisfaction scores improved more than 450% over the past four months.
"Our people on our team were the ones that really pushed the project. Compirion provided the tools to reach their goals. We saw medium performers step up and become high performers. Some people left because this wasn't their thing. Some we allowed to leave," said Williams.
"The medical and nursing staff has been very committed to improving the way things are done. Everyone buying into the change is what made the project successful," commented Compirion's Senior Vice President of Operations.
For the last two years, ETMC Athens leadership had been working on a Surge Plan in the event that capacity in the Emergency Department would exceed its ability to safely treat patients before the ED expansion could be built. The ETMC Athens Emergency Department currently has 15 beds. The new Emergency Department will have 22. After Compirion was engaged, the Surge Plan was added to its list of responsibilities. Compirion and the ED staff returned with a Surge Plan within three weeks.
The Surge Plan took a proactive approach. Additional space was created and five rooms were added on a temporary basis by utilizing some vacant rooms outside of triage and relocating the offices of a department director and coordinator. The ICU waiting room can also be occupied on a temporary basis and turned into two exam rooms. Carts stocked with supplies were added to the new rooms. The plan called for staffing by one MD and one new RN, in addition to the Triage Nurse already stationed in the area. Computer access could be achieved using laptops. The hospital was given formulas and predictive patient visit models for determining when the Surge Plan would be engaged. In the event of a surge, a group identified as the "Call-Back Six" were put "on call" to help until the volume becomes manageable again. The "Call-Back Six" consist of an ED Tech, an RN, a Discharge RN, a Registrar, a Radiology Tech and a Lab Tech.
As Compirion's six-month engagement draws to a close, even with a volume increase of 39%, the overall Length-of-Stay at the East Texas Medical Center in Athens, Texas, is down from 233 minutes to 165. Disposition-to-Inpatient-Bed time is down from 71 minutes to 53 minutes. The number of Patients who Left Without Being Seen baseline was six per day and has dropped to less than two, down 66%. Remarkably, Emergency Department Patient Satisfaction score rankings dramatically improved by more than 450%.
Bywaters added, "From an administrator's viewpoint, they liked the fact that they (Compirion) are hands-on and active throughout the week and weekends. It's crucial to making things happen. They don't use e-mails to communicate. The personalities of the consultants involved were focused, with good people skills, and they were persistent and creative. If something didn't work, they would come up with something else. I shudder to think what would have happened if our friends from Compirion hadn't been here. Now it is busy but not as difficult as it was before Compirion came. It is much better, even at these volumes, now that our process has improved. I am very appreciative that Compirion has helpful, courteous, hardworking and effective people. They have been a pleasure for me to work with."
Williams added, "Compirion 'hands-down' have been great people to work with. Their resources, their people I can't say enough. They have been amazing. It has been an intense project at times and they were very encouraging. They were very sensitive and coached the staff and me. It was a lot of work but it was worth it!"
SOURCE Compirion Healthcare Solutions, LLC