Streamlining how patients move through an emergency room requires good processes and smart technology. When these components coexist, healthcare professionals are armed with the tools they need to provide better quality and more efficient patient care in a high-stress, unpredictable environment.
During a July webinar hosted by Becker's Hospital Review and sponsored by Leidos, two ER experts discussed how lean methodology and systems integration technology have improved the ER operations at Chicago-based Rush University Medical Center.
- Paul E. Casey, MD, chief medical officer of Rush University Medical Center and professor in the department of emergency medicine at Rush Medical College
- Donald Kosiak, MD, chief medical officer of Leidos
Four key takeaways:
1.) ERs are high-stress environments, ripe with opportunities for operational improvements. According to Leidos, half of ER physicians and ER nurses have experienced burnout in the last year. In addition, 75 percent of ER healthcare professionals say they have felt like they should have done more for their patients but didn't have the time, talent or resources to do so. "And just about everyone who has ever worked in an ER has felt the brunt of a patient or family member who has been dissatisfied with wait times," Dr. Kosiak said. "Nearly half of ERs in the U.S. currently have capacity issues that have nothing to do with clinical care, but instead, are related to workflow."
2.) Applying lean methodology is an important starting point for process improvement. "You can't operationalize with technology if you have a really bad process," Dr. Kosiak said. "You'll still have the same results." According to Dr. Casey, Rush started with lean thinking — using pencil and paper — to define problems, identify waste and envision a future state. Operational changes focused on deep dives into "flow cells." Patients were part of low-, medium- or high-acuity flow cells, each with different processes and resources. Rush also created a new position of flow manager.
3.) Systems integration technology must pull data from and work with EHRs. Although Rush had implemented a world-class EHR, this was unable to support operational improvements. "We wanted to provide some sustaining technology that could fill in the gaps around the EHR and focus on operational workflow," Dr. Kosiak said. "It was really about when events happen and whether they fall within the expected parameters." Rush decided to work with Leidos, a leading systems integrator that developed tools to help Rush improve its workflows. Tools provide real-time data, are easy to visually interpret, are used cross-functionally and are agile to support continuous improvement. These tools provide live department stats, such as wait times and progress against goals, displayed on monitors throughout the ER. Tools also provide visualizations and have patient-level drilldowns.
4.) The combination of process improvement and technology implementation has helped Rush improve its ER capacity and performance. Casey stated that Rush notices continuous improvements that are impactful to lowering the "left without being seen" dilemma and sustains positive results. During COVID, Rush was able to treat more than 100 symptomatic patients per day while maintaining regular ER operations. In addition, Rush has improved its patient experience in spite of COVID and has strong anecdotal evidence of increased staff engagement.
To register for upcoming webinars, click here.