When the CEO at Medical Center of Lewisville in Texas was taking calls in the middle of the night from the EDs charge nurse, it was clear the administrators were serious about improving ED throughput.
The hospitals goal was to reduce ED turnaround time to less than 130 minutes — an ambitious time given the average of 199 minutes when the hospital launched the plan in early 2010. Administrators, including the CNO, CEO, CFO and COO arranged a call schedule, and whenever a patient in the Medical Center of Lewisville ED or at the hospitals nearby freestanding Flower Mound (Texas) Emergency Center waited more than an hour to be admitted to the hospital, the ED charge nurse contacted the administrator on call.Shrinking turnaround times in the EDs was a team effort by administrators and nurses, including, from left, Linda Gosselin, RN, clinical supervisor; Clarissa Olmedo, RN, staff nurse; Josh Constantino, RN, staff nurse; and Craig Roberts, RN, director of emergency services, Medical Center of Lewisville.
“Once the charge nurse made the call, the senior administrator would work as a liaison with other departments to help solve the problem causing the delay,” said Michelle Underwood, RN, BSN, MBA, CEN, assistant vice president of Flower Mound Emergency Center. “When we first started, they may have been called as many as three times during the night, but that changed quickly when everyone realized this was a high priority and the senior team was very committed.”
The hospital also created a new nursing position — manager of patient flow/patient advocate, aka “the bed czar” — held by Nydia Henry Glass, RN. Glass is responsible solely for overseeing bed transfers throughout the hospital, which has contributed to decreased turnaround times. “She has been instrumental in coordinating all of the movement in the hospital,” Underwood said. “She has background as an ED nurse, and she understands the dynamics of the different departments.”
The hospital also saw the need for patient flow nurses to prevent delays in admitting patients to the hospital from the ED. These nurses — who work in the med/surg and telemetry units — conduct the initial assessment for patients who are transferring from the ED to one of these units.Michelle Underwood, RN
“In the past, bedside nurses who had four or more patients were being asked to dedicate time to assessing a new patient,” said Craig Roberts, RN, BSN, MBA, director of emergency services for Medical Center of Lewisville. “Now that we have a patient flow nurse to gather all of that initial information, this frees up the bedside nurse to do what he or she needs to do at the bedside.”
It has been more than two years since the hospital set out to reduce the turnaround time, and now administrators rarely receive calls. By the end of 2010, the throughput time was down to 135 minutes for both EDs combined, and in 2011 it dropped to 124 minutes.
In fact, impressive throughput times were an example of excellence that caught the attention of the Emergency Nurses Association, which awarded Flower Mound Medical Center the Lantern Award in August 2011. Flower Mound was one of 20 recipients nationwide — and the first in Texas — to receive the new award. The Lantern Award is given to EDs that exemplify exceptional and innovative performance in the core areas of leadership, practice, education, advocacy and research.
The award also reflects Flower Mounds excellence in practice credibility because the majority of the nurses are certified in their specialty, Underwood said.
Although the award was given to Flower Mound, Underwood said notable turnaround times could not have been achieved without hospitalwide support.
“I think the throughput times were instrumental in getting us recognized by the Emergency Nurses Association,” she said. “But it was a huge facilitywide initiative. Every single department had a role in helping us to improve the throughput.”