ED Optimization Model

Presented By:

Andy Mulvey, MD, FACEP, ED ChairmanRichele Wright MSN, FNP, BC,Divisional Director of Clinical Services

Genesis Cup

ED OPTIMIZATION MODEL

Community Hospital SouthApril 2013

Recognizing Innovation in the ED

© 4/2013 Andy Mulvey, MD, FACEP. All rights reserved.


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…

2


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

33


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.

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NEED TO SUCCEED

• Expert operational assistance • Strong practice management• Recruiting and retention of excellent providers• Utilization of extensive resources • Partnership with CHS leadership

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IN THIS NEED TO SUCCEED

Expert execution, support

and results were delivered. Delivered

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Results Support

Execution

Expertise


STRATEGY AND IMPLEMENTATIONEmCare utilized a top down approach designing

and implementing a whole new E.D. cultureStep 1

Integration of a strong E.D. Chairman and retention of the existing Site Medical Director

Step 2

Identification and retention of providers capable of thriving under the new EmCare model

Step 3

Collaboration with nursing leadership and hospital administration to improve the department

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Andy Mulvey MD, FACEP

ED OPTIMIZATION MODEL8


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



• 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



So what is

The Secret Sauce?



• 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

RESULTS MATTER12


Continuous analysis and improvement of all E.D. dynamics.

All decisions are data driven.

IT ALL STARTS WITH THE DETAILS…

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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



• 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

PATIENT TO PROVIDER STAFFING IS CRITICAL

15


• 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


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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 ScribePhysician with Scribe

Physician with ScribePhysician with Scribe

Mid-level Mid-level

Mid-level - Fast TrackMid-level NEW SHIFT

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• 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

ED EFFICIENCY18


• Departmental interdependency, not silo mentality• Ancillary partnerships and teamwork• Recognize that the E.D. is heavily dependent on

efficient ancillary operations

ED EFFICIENCY19


DISPOSITION, DISPOSITION, DISPOSITION

Reduce LOS• Concentration on disposition, not diagnosis • Hospitalist interface, RAP&GO• Stream line admission process

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Emergentology


• Excellent, efficient care to become the expectation• ED Leaders to uphold no patients leave without

being seen• “Express Care” marketed to public

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IMPROVE CARE TO THE COMMUNITY


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

22


OPERATIONAL RESULTS 23

ResultsDriven


Strong leadership and operational expertise paid off

with significant metric improvements in less than

six months.

RESULTS 24


RESULTS

Left Without Being Seen Rates

Dropped from 3.8 percent to 0.24 percent

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RESULTS

Average E.D. Length of Stay

Improved from 351 minutes to 281 minutes

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HCAHPS AND PATIENT SATISFACTION SCORES ARE

RAPIDLY IMPROVING

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Patient

Physician

OPTIMIZATION EQUATION

Arrivals + Acuity

Factor forStaffing Model

Continual Adjustments

Superior nursing care Administrative supportOperational efficiency

ScribesMid-levels

ED LOS, RAP&GOBedside TriageAncillary services

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Physician Patient

Unwaveringleadership

Obsession with the

operational details

Develop dynamic

nursing and ED team

Fight for what is right Patient

centered care

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So back to The Secret Sauce,

is that it?

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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”

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• 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”

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A FEW MORE INGREDIENTS TO THE SECRET SAUCE…


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



In this journey of success, we “optimized” when our team unified

in providing the best care for our patients.

The “ED Optimization Model” providesthe framework and leadership

to make that happen.



Andy Mulvey, MD, FACEPcell: 317-850-0236

email: [email protected]

Richele Wright MSN, FNP, BCcell: 469-236-5361

email: [email protected]

QUESTIONS?35

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ED Optimization Model

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