How It's Done: Reducing ED Boarding Time at StoneCrest


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The admission process at TriStar StoneCrest Medical Center in Smyrna, Tennessee, was taking over three hours, leaving patients boarding in the emergency department (E.D.) and slowing throughput.
To bring boarding time to a minimum, the hospital utilized EmCare®’s proprietary Door-to-Discharge™ (D2D™) service with Rapid Admission Process & Gap Orders™ (RAP&GO™) evidence-based software. The technology behind the RAP&GO system has made it easy for the E.D. physicians and hospitalists to communicate about patient admissions, provide timely service and better care. In addition, by simultaneously notifying all who are involved in the admission process, RAP&GO has further helped reduce disposition–to–admit times — saving patients about two hours of E.D. boarding.

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How It's Done: Reducing ED Boarding Time at StoneCrest

  1. 1. EMCARE® DOOR-TO-DISCHARGE™ CASE STUDY TriStar StoneCrest placed hospital flow as a top priority because of its significant impact on both the patient experience and hospital performance. Even with exceptional E.D. metrics, the hospital faced the all too common challenges of disjointed processes and inefficient communication between the E.D. and the inpatient units. Learn how EmCare’s Door-to-Discharge™ solution helped.
  2. 2. Challenge TriStar StoneCrest Medical Center, a 109-bed HCA hospital in Smyrna, Tennessee, near Nashville, opened in 2003 with dedication to patient care and satisfaction. Even with a record number of patients in 2012, the hospital’s emergency department experiences 46,000 visits annually and has maintained an average wait time of less than half the national average. With the respective physicians and staff of the emergency department and hospital medicine units working in silos instead of focusing on a broader picture of patient-centered care, the latent dysfunction included: • An average time to move the patient from the E.D. to the inpatient unit of about three-and-a-half hours, time wasted boarding in the E.D. • Patients who were ready to be discharged in the morning still filled inpatient beds well into the afternoon leaving no open beds for new admissions. • Process inefficiencies, breakdowns in communication and poor handoffs caused wasted time and efforts. To solve the patient flow issue, the hospital needed an effective way to align the E.D. physicians and hospitalists and organize the communication between them and all those involved in the admission event. Solution EmCare’s Door-To-Discharge™ (D2D™) service with Rapid Admission Process and Gap Orders (RAP&GO™) software provides an integrated practice model that positions the E.D. and hospitalist physicians to work together on metrics and goals. EmCare’s RAP&GO proprietary, evidence-based software uses InterQual* criteria for the top ten conditions that are admitted to the E.D. with all admission criteria agreed upon in advance by the E.D. physicians and hospitalists at each facility. In addition, the software expedites the process by sending automated messages regarding the patient’s admission status to the pager or cell phone of the hospitalist, nurse manager, bed manager, house supervisor and others - simultaneously. In this case, EmCare’s D2D program, supported by RAP&GO, helped the physicians move patients through the admissions process with maximum efficiency. The physicians collaborated to reduce hospital LPT/ LPMSE rates, reduce E.D. boarding time and improve patient care quality and satisfaction while opening up needed E.D. beds. EmCare’s RAP&GO made it easier. EmCare is the only company in the industry that uses this technology to improve hospital-wide patient flow. *InterQual is a registered trademark of McKesson. “From the first day I used it, I loved it! I can login to any computer anywhere and get the information I need or update the patient status. All the calls back and forth are eliminated. No more “Let me call you back!” – where sometimes 30, 40, or 50 minutes would pass before you heard back. We can now stay ahead on beds as everyone who needs the message gets the message at the same time.” – House Supervisor TriStar StoneCrest Medical Center
  3. 3. By the numbers 15% IMPROVEMENT 35% IMPROVEMENT E.R. VOLUME 2011 20122011 2012 2011 20122011 2012 LWBS 00 00 15,00015,000 0.30.3 30,00030,000 0.60.6 45,00045,000 0.90.9 60,00060,000 1.21.2 Results The before and after results from EmCare’s D2D with RAP&GO were outstanding: Disposition to admission (boarding time) dropped from approximately 210 minutes to 80 minutes almost immediately. Additional metric improvements: • LWBS decreased from 0.99% to 0.64% Reduced boarding time in the E.D. meant more patients could be seen in the E.D and patient volume increased from 38,940 to 46,043. -130 MINUTES Before AfterBefore After EMCARE’S D2D WITH RAP&GO IMPLEMENTATION 00 60 MIN60 MIN 120 MIN120 MIN 180 MIN180 MIN 240 MIN240 MIN
  4. 4. FIND OUT MORE TODAY! Call: (877) 416-8079 “What makes it work so much better? There are several factors that contribute to the efficiency. The E.D. physicians no longer have to handwrite the orders. With a paper system, they would start writing the order then get interrupted – often many times – before they could get the order completed. The hospitalist is paged by the RAP&GO system. The hospitalist then logs in to RAP&GO to accept the patient. Once the E.D. physician is notified of the acceptance, he or she simply prints the completed orders from the system. The system automatically pages the house supervisor/bed manager, charge nurse and case management – simultaneously. So, it doesn’t take 20 phone calls to get a patient admitted anymore. The telephone calls have practically been eliminated. Once the unit clerk in the E.D. has the bed assignment for the patient, that number is entered into RAP&GO which notifies the hospitalist there is a patient to be seen giving the room number, diagnosis, notes, etc. The hospitalist acknowledges when the patient has been seen and the cycle is complete. And if any step in the process goes beyond the agreed time, the notification is escalated to the appropriate leader so that he or she can address any issues. Any time you can write less, it saves time…. time that can be spent on patient care.” – Corbi Milligan, MD Hospitalist Medical Director TriStar StoneCrest Medical Center