Case Studies
Hospital Physician Partners’ collective experience includes the development and/or implementation of many Emergency Medicine standards, best practices and programs. From Fast-Tracks and 30-minute No Wait guarantees to clinical leadership protocols and documentation trainings, Hospital Physician Partners is an industry leader in delivering service excellence.
Low Patient Volume, Poor ED Performance and Ineffective Medical Leadership
Analysis:
Valley Medical Center is a community based hospital in Spokane, Washington that was receiving lower than targeted annual Emergency Department (ED) visits. Despite aggressive population growth in the area, the growth rate in patient volume at Valley was poor. Additionally, Left Without Being Seen (LWBS), patient Turn Around Time (TAT) and patient satisfaction scores were all below hospital goals and expectations.
Goal:
Establish new medical leadership, improve Patient Satisfaction and increase ED performance
Summary:
Increased patient volume and satisfaction and improved overall department efficiency
Results:
Realizing that strong medical leadership and collaboration was the key to an effective turn-around, Hospital Physician Partners immediately brought in a new Medical Director to lead the ED team. After obtaining the full support of hospital administration and creating a partnership strategy with the hospital medical staff and ED physicians and nurses, performance began to turn around. Initial ED volume of 26,000 rose to 45,000, Press Ganey scores at the 13th percentile improved to the 90th percentile and TAT decreased from 3.4 hours to 1.9 hours. Additionally, Hospital Physician Partners initiated the implementation of a Fast Track staffed by physician assistants.
ED Performance Improvement
Analysis:
Southwest General Hospital is a 40,000 visit Emergency Department (ED) on the south side of San Antonio, TX. The ED sees a relatively high acuity and had difficulty moving patients through the department into patient beds.The percentage of patients leaving without seeing a physician (LWBS) was over 20% and length of stay (LOS) exceeded 6 hours.
Goal:
Reduce LWBS and LOS and enhance ED performance
Summary:
Increased through-put, enhanced efficiency and implemented performance tracking processes
Results:
With leadership of the on-site ED Medical Director and support from Hospital Physician Partners' corporate clinical leaders, dramatic changes occurred. While progress took several months, results were impactful. Adjustments to staffing patterns to match peak volumes assisted in moving patients. LWBS was reduced to 3%. The development of a 6 bed in-patient admissions unit dramatically decreased the LOS for patients being admitted to the hospital to under 3 hours. The improved working conditions in the ED made it easier for the hospital to recruit both physicians and nursing staff in other departments. Additionally, Hospital Physician Partners assisted in the purchase and development of an EDIS so accurate and real time measurement of ED performance could be reported against targeted goals.
Inappropriate Discharges and Under-Performance
Analysis:
Missouri Southern Hospital is a rural community hospital in southern Missouri. The Emergency Department (ED) census is approximately 10,000 patients a year. When Hospital Physician Partners first became associated with the facility, there was a concern that patients who were better served in an inpatient setting were being discharged. Attending staff had several instances of admitting patients from their offices just a day or two after an ED visit.
Goal:
Improved and Appropriate Discharge Practices and Performance Improvement
Summary:
Enhanced Performance Improvement and Increased Patient Admissions
Results:
Hospital Physician Partners created and implemented a performance improvement program focusing on high risk discharged patients. Corporate Clinical leadership met with the local physician group on several occasions reviewing a risk aversive perspective in patient care and encouraging physicians to focus on patient safety. Individual benchmarks and statistics were reported to the providers; transparency within the group had a large impact on performance. Over a 6 month period, risk taking practice patterns decreased. The admission rate climbed into a range projected on a proprietary risk monitoring system. This pattern has been sustained over several years.
Patient Boarding and Throughput Challenges
Analysis:
North Vista Medical Center is a community hospital on the northern edge of downtown Las Vegas, NV with an annual Emergency Department (ED) volume of approximately 35K. Length of Stay (LOS) and Left without Being Seen (LWBS) rates were unacceptably (>20%) high despite the opening of a new ED within recent months. A significant percentage of the patient population is mental health patients who require psychiatric assessment before they are discharged after medical clearance. Because of a limited number of available psychiatric beds throughout the Las Vegas community, patients often waited days until an available bed opened up for their transfer. The ED was often holding upwards of seven or eight mental health patients a day (30% of the ED beds)
Goal:
Reduce boarding of psychiatric patients and increase patient through-put
Summary:
Reduced patient boarding, maximized utilization and decreased LOS
Results:
The number of mental health patients decreased in the ED as did the overall LOS. Hospital Physician Partners clinical staff, in conjunction with the local leadership encouraged the hospital to seek the services of a psychiatrist to round once a day in the ED to clear those patients that did not require an inpatient unit. Additionally, the psychiatric patients were sequestered to one area of the ED, utilizing only 2 or 3 rooms and having security posted nearby. With more beds available to the general ED population, the percentage of patients that LWBS decreased to 3%. In addition, an EDIS was implemented through Hospital Physician Partners' direction providing measurable performance reporting both as for department and individually for providers.