Emergency Department Setting:

  • Community Hospital
  • 29,000 annual ED visits
  • 18 ED beds

Challenge:

  • To improve customer service within the Emergency Department

Efforts:

Physicians:

  • Report Press Ganey scores and medical staff meeting quarterly
  • Report Press Ganey scores in ED Group meeting
  • Customer service articles presented in ED Group meetings
  • Annual evaluations included customer service feedback
  • ESP presented Risk Management in-service including large customer service component
  • ED physicians are rewarded quarterly with gift certificates for most customer service compliments
  • ED physicians are involved in PI teams and community programs
  • ESP has successfully recruited a stable core staff

Nurses:

  • Hospital-wide process improvement team formed for working on ED length of stay (LOS); continues as Department Improvement Team
  • Ongoing Department Improvement Team for customer satisfaction, education, and community awareness
  • Nurses expected to round every hour to keep patients/families informed
  • Studer Group education with each staff member evaluated as high/medium/low performer
  • Nurses give personal business cards to each patient at introduction
  • Use of instructional video in the ED waiting room to explain ED process, expectations, and potential delays
  • New brochure in development for the same information as above
  • Department maintains a supply of $10 H-E-B grocery gift cards to be presented to patients when they experience an unexpected delay in care attributed to breakdown in the hospital process

Input Processes:

  • ED Greeter: A greeter is stationed at the front door of the ED waiting area, 14 hours per day, to greet (with a smile) every walk-in patient upon arrival and to ask, “What brings you to the ED today?”
  • Bedside Triage: Eliminated triage as a location in the traditional sense and emphasized triage as more of a process that occurs at the bedside when possible and not necessarily before the initial physician evaluation, thus helping to reduce the time from patient arrival to physician assessment.
  • “Pull ’til Full”: Because walk-in patients can now bypass the traditional triage location, patients are immediately brought back to an ED bed (as long as one is available), reducing the need for patients to sit in the waiting room.
  • “Meet and Greet”: Physician makes initial contact with each patient within 30 minutes of arrival to “get things started”(i.e., order labs, pain meds, IV fluids, antiemetics), often before a comprehensive evaluation is performed.

Results:

  • 97th percentile ED rank and 99th percentile ED physician rank!
  • Decreased door-to-provider time to consistently ≤30 minutes.
  • Decreased rate of patients who left without being seen (LWBS) from 4.2% to 0.7% in just 10 months, and maintained consistently at ≤2%.

Figure 1. Emergency Department Patient Satisfaction

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Figure 2. Decrease in Door-to-Provider Time

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Figure 3. Decrease in Patients Left Without Being Seen

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