Meadows Regional Medical Center applied lean manufacturing principles, as originally developed by the car maker. The medical center refined its emergency processes, ultimately slashing its average length of stay in half. As a result, the hospital now handles a growing patient volume more efficiently. And it has increased the department's annual revenue 35% since launching the project.
The emergency department revamp is the first foray into electronic health records and computerized physician order entry for the 87-bed hospital in Vidalia, says Peggy Fountain, emergency department director. "We had the most to gain in the ER," she says, pointing to the 247 minutes, on average, that patients stayed in the department, higher than the national average.
As a result of its new-found efficiencies, the hospital slashed that average to 122 minutes in less than three years.
A key factor in the improvement, Fountain observes, was the implementation of an emergency department information system from T-System Inc., Dallas.
Teamwork
Because the large rural area the hospital serves faces a shortage of physicians and an aging population, the facility's 13-bed emergency department is extremely busy, Fountain says. In 2007, it treated 27,000 patients, and the hospital expects that figure to rise to 30,000 this year. "We run out of space from about 11 a.m. to 10 p.m. every day," she adds.
Faced with difficult ED challenges, the hospital's CEO turned to his alma mater, Georgia Tech, for help. The university provided free advice, offering experts in lean manufacturing who helped clinicians from throughout the organization identify ways to eliminate wasteful tasks. Some 44 action items were identified. These ranged from implementing the new software to taking such steps as cross-training hospital nurses so they could pinch-hit in the emergency department during crunch times.
The hospital has clinical and financial information systems from Medical Information Technology Inc., Westwood, Mass., but has yet to automate clinician's progress notes. As a first step toward implementing a more comprehensive EHR, executives chose to seek out a system specifically designed for emergency departments, Fountain says.
Documenting Treatment
Now, a triage nurse uses the T-System application to create a record for non-critical emergency patients. Then doctors and nurses treating the patient use the record to document care using pre-defined templates for specific types of cases. The clinicians use a mix of wireless tablet computers from Motion Computing Inc., Austin, Texas, desktop PCs from Dell Inc., Round Rock, Texas, and Dell laptops.
The department is experimenting with hardware options as it prepares to double the size of the ED.
In yet another effort to use automation to improve efficiency, the hospital worked with T-System to develop a way to easily monitor the progress of each case. A 42-inch plasma monitor, concealed at a nursing station, lists information on each patient, including how long they've been at the facility and what the next steps are in their treatment, Fountain explains.
The T-System software also enables Fountain to generate about 30 reports, analyzing such factors as the amount of time a particular physician spends with patients as well as patient acuity levels. The hospital uses an outside firm to provide emergency physicians. That company uses the reports to help ensure appropriate staffing levels, she says.
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