400-O. Super Heroes Should Not Have to Wait

Article Outline

• Purpose
• Design
• Setting
• Subjects/Participants
• Methods
• Results
• Recommendations
• Copyright

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Purpose 

Super Heroes was a campaign promotion designed for the public to recognize there is a “Super Hero” around every corner – whether they are patients, families, or staff. The organization's President and CEO designed the 29-minute initiative. One important focus is that the patients and their families are Super Heroes. This initiative is a door to doctor guarantee to the families and patients served by the emergency department (ED) that they are treated within 29 minutes of arrival or the hospital will acknowledge failure to meet the guarantee. These patients receive complimentary tickets to a local event. This initiative addressed extended wait times in the emergency department and the left without being seen (LWBS) population.

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Design 

The 29-minute initiative is a quality improvement project with a patient/family and staff satisfaction component. The objective is to treat 95% of all patients that come into the ED within 29 minutes. Management reviews daily reports of those patients meeting and not meeting 29 minutes. Work is in progress and there are many matrixes targeted for process improvement at some point in time.

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Setting 

The site is an urban, Level I Trauma Center teaching facility located in southeastern Michigan, the only freestanding Level I Trauma Center children's hospital in the state.

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Subjects/Participants 

Every full-time employee of the hospital has their own specific role in this initiative (including the charge nurse ensuring smooth ED flow, the ED doctor's disposition of patients, and the housekeeping staff). The hospital tracks 100% of all patients that arrive at the emergency department.

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Methods 

Upon patient arrival, a simultaneous “mini-registration” and triage is completed. The clock starts ticking for the 29-minute limit upon completion of the mini-registration component. The current triage process ensures a maximum length of 3 minutes. The department is a wireless environment that provides for a complete bedside registration. Any other services required for patient care and/or treatment happens at the patient's bedside.

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Results 

Improving turn around times in conjunction with the 29-minute initiative has decreased the average length of stay (LOS): 245 minutes in 2003, 196 minutes in 2004, and 153 minutes year-to-date. Patients who were LBWS were 4.26% in 2003, 2.15% in 2004, and 0.74% year-to-date. Patient volume has increased by 17%.

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Recommendations 

At the initiative onset, August 2004, the emergency department met the guarantee 54% of the time, on average. Current commitment compliance is 98%. Continued monitoring of every matrix that affects patient wait times is an ongoing focus. Many factors contribute to the initiative's success. Emergency department patient arrival and flow, acuity level, and inpatient bed availability are the most important factors at this time.