Accreditation

MD hospital wins award for flow improvements

Briefings on The Joint Commission, January 1, 2006

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Hospital reduces ambulance diversion, increases satisfaction

Learning objectives: After reading this article, you will be able to

1. identify the JCAHO standard regulating patient flow

2. list staff responsible for improving patient flow

3. identify how to use data to improve flow

Shady Grove Adventist Hospital in Rockville, MD, was suffocating.

A backlog of patients clogged the 269-bed hospital from the emergency department (ED) all the way through to discharge. The logjam forced the second-busiest ED in Maryland (behind The Johns Hopkins Hospital in Baltimore) to divert ambulances to other Montgomery County hospitals. Those four other county hospitals then had to divert ambulances as well, placing patients at greater risk.

"It [became] very clear to us that we couldn't keep our hospital open unless we looked at the issues affecting us," Shady Grove Adventist President Deborah Yancer says. "We didn't feel that [diverting ambulances] was acceptable."

That attitude won Shady Grove Adventist the 2005 Ernest A. Codman Award from the JCAHO for its use of outcome measurement to improve patient flow. The hospital received the award November 9, 2005, in Chicago.

The hospital began evaluating patient-flow data and implemented several changes, including hiring a clinical bed coordinator, implementing computerized bed tracking, creating earlier discharge times, and adding a short-stay unit for patients who would be in the hospital for less than 24 hours, says Debra Foshee, vice president of quality and medical staff services.

Thanks to those and other changes, length of stay (LOS) in the ED fell from 397 minutes to 372 minutes in little more than a year. The number of ambulance diversions fell by 72%.

JCAHO standard LD.3.15 requires leadership to develop and implement plans to allow efficient flow throughout the hospital, and scrutiny could intensify even more in the future under revised leadership standards proposed for 2007.

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