ED Throughput - St. Francis Medical Center
The Case: St. Francis Medical Center, Monroe, LA
The Challenge
St. Francis Medical Center’s downtown ED had an average wait time of nearly four hours. Physicians were frustrated. Staff was frustrated. Patients were frustrated – so much so that 6.6 percent of them left without being seen (LWBS) – impacting the hospital’s bottom line and its image within the community. The hospital realized it needed to improve its ED throughput and called on QHR for help.
“In addition to its LWBS losses, which represented $2.03 million in opportunity and approximately $1.01 million in realizable gain, St. Francis’ ED had 3,883 hours of diversion annually. This represented $152,000 in opportunity for the hospital, with an approximate $76,000 in realizable gain,” said QHR Clinical Operations Practice Leader Pat Cooper.
“The ED was also running at 3.40 hours per patient visit, rather than the target of 2.58. This represented a potential opportunity of 8.4 RN FTEs and $420,000. Long story short, the hospital was leaving money on the table.”
Q Solutions
QHR’s first task was to help implement changes to the physical layout of St. Francis’ ED space, which contributed signifi cantly to the department’s throughput problems. The space suffered from:
- A small, cramped waiting room
- Only one triage space
- Small trauma rooms
- No dedicated psychiatric beds
- A nurses station that wasn’t entirelyfunctional and that contributed to high noise levels
“QHR helped us reconfigure our existing ED space – enabling our Fast Track to be located within ED proper and increasing our number of patient care areas from 18 to 26. Our registration and triage areas were renovated to produce increased efficiency, and our new sub-nursing stations have helped decongest the main ED nursing station – providing both physicians and nursing staff with improved work space,” said Darline Smith, St. Francis’ Vice President, Patient Services. “Improving our physical plant has really improved work flow, staff and physician satisfaction, and, most importantly, patient care.”
QHR also helped St. Francis develop and implement policies and procedures that reduced their average ED length of stay at all acuity levels. Together, QHR and St. Francis:
- Replaced the hospital’s 3-level triage system with the ESI Level 5 system. The new system supports correct placement within the ED and safer prioritization of care of patients
- Established benchmarks for all acuity levels
- Modified Fast Track criteria to included a greater number of Level II (Urgent) patients
- Created performance standards for Fast Track area
- Fully developed Case Management in the ED
- Implemented an improved patient tracking system
In addition, QHR helped St. Francis reduce its nursing hours per patient, by:
- Matching RN (total) hours to current average in-patient volume
- Implementing a mandatory on-call process
- Utilizing Triage Nurse and Charge Nurse for patient discharges and lower acuity patients
- Reducing core RN staffing during non-peak hours
The Conclusion
Wait times decreased by 80 minutes, reducing the hospitals LWBS rate from 6.6 to 2.7 percent – or $1,993,766.
The total financial impact of this engagement was $3.3 million with a 6.56 return on investment.
