Meadows Slices ER Wait Times

HDM Breaking News, May 8, 2009

Meadows Regional Medical Center has cut in half the length of time a patient stays in its emergency room by embracing the lean manufacturing practices first implemented in the automotive industry. But the hospital, unwilling to rest on that achievement, put in place in April a system to reduce ER wait times even further.

The 122-bed facility in Vildaltia, Ga., has reduced ER stays from 247 minutes to 125 minutes, which is making it possible for the department to treat more patients. Where, two years ago, the unit saw 60 patients a day, it now treats 100 or more people daily.

"It's been an incredible success," says Matt Haynes, a health care efficiency specialist who works with a group at Georgia Tech that consulted with Meadows on how it could improve its operations.

A key piece of Meadow's "lean hospital" effort is its emergency department information system from T-System Inc., Dallas. The system automates and coordinates critical ER tasks such as triage, patient tracking, and documentation, among others. The EDIS was installed in the second half of 2005.

But, as in the case of lean manufacturing, which is designed to drive out waste and inefficiencies while also instilling a sense of continuous process improvement, the hospital is looking to do even more. In April, Meadows upgraded its EDIS with a computerized physician order entry system, which it hopes will lead to an additional 30-minute reduction in ER patient stays.

The hospital's search for ER efficiencies started in 2004. By then, the average length of ER stays had grown to 200-plus minutes and, on some days, reached an intolerable 300 minutes. The hospital's managers decided something had to be done.

The hospital turned to Georgia Tech's Enterprise Innovation Institute, a consulting arm of the university. The institute was looking to bring the benefits of the lean manufacturing principles first developed at Toyota to other industries.

Georgia Tech thought that if lean manufacturing worked in other businesses, it ought to work in healthcare, says Peggy Fountain, the director of Meadow's emergency department. And, she adds, "I was ready to do anything to improve our wait times."

In June 2005, Georgia Tech specialists came in, studied the organization, and made a list of more than 40 recommendations to improve the hospital's processes. Among the changes that were subsequently made, according to a paper put out by Georgia Tech, were standardizing mobile supply stations; labeling racks, trays and drawers; and adding a holding area for patients who could be treated without putting them in a room.

In addition to those recommendations, the hospital decided to implement an emergency department information system. Fountain now considers the system as key to the hospital's lean health care drive. The EDIS features a documentation system, charting tools, integration to other clinical systems, and an interactive dashboard--all of which make the ER more efficient by giving doctors and nurses instant access to patient data, lab and x-ray results.

The EDIS implementation presented a few change-management issues. At first the doctors and nurses were apprehensive about using the system, thinking it would add extra steps, and time, to their day. But once the system was installed and they started to see the benefits of having real-time information, "they just grabbed it and ran with it," says Fountain.

The system was integrated to the core hospital information system from Medical Information Technology Inc. of Westwood, Mass. The integration task turned out smoother than envisioned. "We thought there would be lots of issues," Fountain says. But the hospital spent considerable time planning the integration and extensively testing the systems, and those investments paid off.

Fountain is hoping that the addition of CPOE will enable the ER to cut another half hour off patient treatment time. And, she says, Meadows will continue to look for ways to improve its processes. "Things change. And you have to be willing to change and go along with it."

--John McCormick

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