E.R.: 30 Minutes Guaranteed
Imagine a world in which your wait for treatment at the emergency room was less than 30 minutes.
Take it further: Imagine that if your wait exceeded 30 minutes, you’d receive a letter of apology from a hospital executive.
This 30-minute guarantee went from imagination to reality at facilities in the Bon Secours Health System, with help from Notre Dame’s Executive Education program.
Joe O’Hannigan, senior associate director of executive programs, and program faculty took on the challenge in September 2008: to make the 30-minute guarantee a reality in three hospitals and one stand-alone emergency room within three months.
They set up meetings at the Hampton Roads hospital in Virginia, where emergency room personnel and hospital executives explained the bottlenecks they face, and everyone brainstormed solutions. Meetings were short, and a consensus forced at the end. “If you don’t have all the stakeholders and a disciplined process and keep it moving, it won’t work,” O’Hannigan said.
The 30-minute goal was achieved not by removing one big bottleneck, but many small ones. They included:
Patient discharge practices: Formerly, hospital staff would delay admitting emergency room patients because they did not have an open bed. Often, this was because doctors were not discharging patients until midday, and nurses were not entering discharges into the computer until hours later. The new system dictated that within 10 minutes of a discharge,
that information had to be entered into a computer and a
bed readied for the next patient.
Improved computer access: Previously, a nurse in the consulting room would jot down information on paper about a patient, and then walk down a hall to enter it on a computer. Now, computers are in or right
outside the room, and the nurse keys in the information immediately and only once, thus reducing time and errors.
Prior to the initiative, patients entering the four facilities waited, on average, an hour or longer to get treatment. Within three months of implementing the program, emergency room wait times to get treated by a doctor or nurse practitioner had been reduced to less than 30 minutes and even lower in the months following. The four facilities were reaching their 30-minute pledge for nearly 90 percent of patients, according to Michael K. Kerner, CEO of Bon Secours Hampton Roads Health System.
“The medical staff initially was skeptical and thought it was a marketing gimmick, but then they saw it was truly an improvement,” Kerner added.
The initiative changed the
hospital culture to be more
efficient, said Valerie Sommer, emergency department nurse
manager at Mary Immaculate
Hospital in Newport News, Va. Also, the consultants helped her understand what hospital executives are looking for in proposals to improve systems. “Now we are able to move forward and actually make changes—and not just talk about them,” she said.