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Shortening the wait in ER

Patient Access Weekly Advisor, November 21, 2007

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The 143-bed St. Mary's and 300-bed St. Joseph offer acute care, outpatient, and extended care services. They implemented a 30-minute wait rule in June with an aim to trim wait times for ED patients and improve their satisfaction.

"We started looking at ED performance because we knew there were things we needed to do better," says Debbie Gengler, RN, director of emergency services for St. Mary's. "Our initial plan was to get to the point where patients would have a length of stay in the ER of 90 minutes. We started doing things to see if we could get there."

St. Mary's began in August with committee meetings involving radiology, patient access representatives, and staff nurses and doctors. They recorded times for patient visits to the ED. They broke down the problems step by step, from the time a patient parks to the time he or she checks out and leaves the hospital.

Parking. The first problem the team identified actually began outside the hospital-in the parking lot. "We did a patient-mapping process and went to the parking lot," says Gengler. "What are the obstacles? One of them was we didn't have designated emergency patient parking areas. You would have visitors parking there, and it's sort of inconvenient for a person with an injured ankle to have to hobble in to the emergency room."

Registration. When a patient comes in the door at St. Mary's, he or she is immediately greeted at the front desk. Before, Gengler says, the center had the front desk covered only 12 hours; now, it's 24.

On-site radiologist. St. Mary's has a radiologist technician dedicated to the ER who tracks patient flow and anticipates the need for imaging. "He's keeping tabs on what's going on and anticipating any need for imaging services."

Quick cleaning. Rooms are getting cleaned faster now, ensuring a smooth transition for new patients. Employees are also clearing out rooms on the inpatient side faster for a quicker transition from the ER.

Staff incentives. The facilities recognize staff work on the 30-minute initiative. They give coupons for free meals and other perks. "So if you have a day when you hit 99 or 100%, we say, 'Thanks for all your hard work,' " says Gengler.

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