ED Optimization Model
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EmCare was hired to optimize operations at the emergency department of Community Hospital South in Indianapolis. They implemented a top-down approach, focusing on strong physician leadership, instituting a culture of excellence, and data-driven decision making. Key changes included bedside registration, team nursing, and optimized staffing models. Metrics improved significantly within 6 months, with left without being seen rates dropping from 3.8% to 0.24% and average length of stay decreasing from 351 to 281 minutes. Continued focus on recruitment, staff satisfaction, documentation, and aligning with hospital goals helped sustain these operational improvements.
ED Optimization Model
- 1. Genesis Cup Recognizing Innovation in the ED ED OPTIMIZATION MODEL © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 2. 2 COMMUNITY HOSPITAL SOUTH Indianapolis, Indiana Over 40,000 annual E.D. visits • Community Health Network - a leading not-for- profit health system in Indianapolis, Indiana • Community Hospital South (CHS) - serves the south side of Indianapolis and Johnson County • June 1, 2012 the journey began… © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 3. 3 3 THE CHALLENGE OF INSTITUTIONAL CHANGE Need to improve the overall quality of care and patient metrics of the emergency department Desire for increased patient volume Epic EMR roll-out set for August 2012 Previous E.D. physician group unable to attain the ambitious goals of hospital administration © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 4. 4 NEED TO SUCCEED Improvements to E.D. dynamics and overall efficiency were expected and they needed to happen fast. Expert vision and strategy was required to drive these changes and to optimize patient care quality. © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 5. 5 NEED TO SUCCEED • Expert operational assistance • Strong practice management • Recruiting and retention of excellent providers • Utilization of extensive resources • Partnership with CHS leadership © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 6. 6 6 IN THIS NEED TO SUCCEED Expert execution, support and results Expertise were delivered. Delivered Execution Results Support © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 7. 7 STRATEGY AND IMPLEMENTATION EmCare utilized a top down approach designing and implementing a whole new E.D. culture Step 1 Step 2 Integration of a strong E.D. Step 3 Identification and Chairman and retention of Collaboration with retention of the providers capable nursing leadership existing Site of thriving under and hospital Medical Director the new EmCare administration to model improve the department © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 8. 8 ED OPTIMIZATION MODEL Andy Mulvey MD, FACEP © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 9. 9 ED OPTIMIZATION MODEL Strong Physician leadership Create a vision for the E.D. and stay the course Enable key players to ensure success is achieved Great leaders foster the success in others Establish partnership with nursing leadership Institute an E.D. culture of success Patient centered care highest priority Teamwork and competitive environment © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 10. 10 ED OPTIMIZATION MODEL • Implement a patient focused E.D. staffing model wherein excellent, efficient care is the gold standard • Improve staff teamwork and physician-nurse collaboration • Optimize physician-patient interactions • Optimize utilization of physicians, mid levels and scribes © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 11. 11 ED OPTIMIZATION MODEL So what is The Secret Sauce? © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 12. 12 RESULTS MATTER • The Secret Sauce is all about your leadership and quest for excellence • When you lead by example, the other pieces fall into place • Strong leadership is willing to fight for what is right • Strong leadership doesn’t always make new friendships • Successful leadership upholds patient advocacy © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 13. 13 IT ALL STARTS WITH THE DETAILS… Continuous analysis and improvement of all E.D. dynamics. All decisions are data driven. © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 14. 14 ED OPTIMIZATION MODEL Patient throughput is the key metric: • Neither triage nor the E.D. is static - your patient care should not be either • Bedside triage and registration implemented • Patient care is seamless and coordinated • Patient care is not linear, multiple things can happen at the same time • Anticipating and being prepared for all possibilities enhances delivery of care © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 15. 15 PATIENT TO PROVIDER STAFFING IS CRITICAL • Ensure that physicians are doing physician level work • Appropriate patient to provider staffing ratios established based on acuity and care needed • Provider staffing adjusted to volume and acuity trends • Physician and MLP team at patient bedside is enhanced © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 16. 16 PATIENT TO PROVIDER STAFFING IS CRITICAL • Appropriate use of mid level providers for lower acuity and time consuming procedural work • Use of scribes to manage secretarial work and promote MD efficiency • EmCare office support to reduce non-clinical burden © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 17. 17 PATIENT TO PROVIDER STAFFING IS CRITICAL 6am 7am 8am 9am 10am 11am 12pm 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm 9pm 10pm 11pm 12am 1am 2am 3am 4am 5am Physician with Scribe Physician with Scribe Physician with Scribe Physician with Scribe Mid-level Mid-level Mid-level - Fast Track Mid-level NEW SHIFT © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 18. 18 ED EFFICIENCY • Team nursing implemented to further expedite patient care • E.D. teamwork promoted • “Yes we can” attitude upheld (Disney model) • Fierce drive to be better than the competition © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 19. 19 ED EFFICIENCY • Departmental interdependency, not silo mentality • Ancillary partnerships and teamwork • Recognize that the E.D. is heavily dependent on efficient ancillary operations © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 20. 20 DISPOSITION, DISPOSITION, DISPOSITION Reduce LOS • Concentration on disposition, not diagnosis • Hospitalist interface, RAP&GO • Stream line admission process Emergentology © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 21. 21 IMPROVE CARE TO THE COMMUNITY • Excellent, efficient care to become the expectation • ED Leaders to uphold no patients leave without being seen • “Express Care” marketed to public © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 22. 22 IMPROVE CARE TO THE COMMUNITY EMS relationships are extremely valuable • EMS control and education expanded • Engaged medics in team approach to patient care • Established place for EMS within E.D. • Teambuilding events for EMS and E.D. staff © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 23. 23 OPERATIONAL RESULTS Results Driven © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 24. 24 RESULTS Strong leadership and operational expertise paid off with significant metric improvements in less than six months. © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 25. 25 RESULTS Left Without Being Seen Rates Dropped from 3.8 percent to 0.24 percent © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 26. 26 RESULTS Average E.D. Length of Stay Improved from 351 minutes to 281 minutes © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 27. 27 HCAHPS AND PATIENT SATISFACTION SCORES ARE RAPIDLY IMPROVING © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 28. 28 OPTIMIZATION EQUATION Patient Arrivals + Acuity Physician Factor for Staffing ED LOS, RAP&GO Superior nursing care Model Bedside Triage Administrative support Ancillary services Operational efficiency Scribes Mid-levels Continual Adjustments © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 29. 29 ED OPTIMIZATION MODEL Unwavering leadership Fight for what Obsession with the is right operational Physician Patient Patient details Develop centered care dynamic nursing and ED team © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 30. 30 ED OPTIMIZATION MODEL So back to The Secret Sauce, is that it? © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 31. 31 A FEW MORE INGREDIENTS TO THE SECRET SAUCE… • Data driven decisions never end • Recruitment for the best talent never ends • Provider satisfaction is paramount to retain the best talent EmCare established provider contracts with incentives/ “skin in the game” © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 32. 32 A FEW MORE INGREDIENTS TO THE SECRET SAUCE… • Eliminate the bottom 10% of low-performers annually • Continuous documentation education is critical to decrease risk and capture billables • Stay aligned with hospital leadership and their goals • Epic EMR was implemented with success - “Planned Internal Disaster” © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 33. 33 ED OPTIMIZATION MODEL Remember that culture of excellence? It was developed. • Studer presentations, 1:1 provider coaching • Endless ED improvement meetings and brainstorming events • Engaging staff in Best Practice and Lean methodologies • Team building events • Outreach events events to all hospital departments, supporting specialties and our patient population © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 34. 34 ED OPTIMIZATION MODEL In this journey of success, we “optimized” when our team unified in providing the best care for our patients. The “ED Optimization Model” provides the framework and leadership to make that happen. © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.
- 35. 35 QUESTIONS? Andy Mulvey, MD, FACEP cell: 317-850-0236 email: awmmdp@yahoo.com Richele Wright MSN, FNP, BC cell: 469-236-5361 email: richele.wright@emcare.com © 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.