December 14, 2011 1:19:00 PM
Last November, Baptist Memorial Hospital-Golden Triangle's emergency department faced a dilemma: No matter what the staff did, patients were unhappy. Surveys ranked the ER in the 17th percentile for patient satisfaction. And despite their best efforts, scores were still plummeting.
One year later, the department has orchestrated a turnaround, with department heads speaking recently at the Press Ganey National Client Conference in Grapevine, Texas, about what did and did not work in improving patient care and satisfaction.
They knew that time was a sticking point, said Diane Gann, emergency department director. Around 50,000 patients come through the ER each year, and the average wait time was three to four hours.
To make the wait more palatable, staff made the waiting room cozier, offering blankets, pillows and hot coffee. They put TVs in emergency patients' rooms.
To speed things up, they added six beds and a third triage station. They made staffing changes, adding a triage coordinator, a nurse manager and licensed practical nurses at the front desk. They implemented bedside registration and educated staff on identifying needs, keeping patients informed and answering questions.
Patient satisfaction still did not improve. As scores dropped, so did employee morale. And they were seeing more and more patients every day.
"We knew we had to find a way to push these patients through quicker," said Crystal Kelley, emergency department nurse manager.
They hired a consultant, Press Ganey, to help them work on efficiency and perception of care. They culled 4,346 charts from September 2010 and analyzed the data. They spent hundreds of hours implementing more changes.
But in the end, it was worth it, Gann said. Baptist's ER now ranks in Press Ganey's 97th percentile for patient satisfaction, and they've dropped the average length of stay to two hours and 25 minutes.
One of the bigger changes was the development of the Rapid Diagnostic Area, which is staffed seven days a week with both a registered nurse and nurse practitioner trained to handle less severe cases, which could range from a toothache to a sore throat.
That freed up time for staff to tend to more serious cases such as chest pain, abdominal pain, upper respiratory issues and shortness of breath.
"Patient satisfaction, we really, truly believe, is about time," said Keith McCoy, medical director of the emergency department. "Patients want to get things going in a timely manner and want to perceive things are moving, and we're addressing their issue continually while they're here ... Those other things (coffee in the waiting room, etc.) let patients know we care, but it really didn't change the length of stay in the emergency room."
The challenge now will be to sustain that level of satisfaction while continuing to improve, McCoy said.
Gann said improvements could not have taken place without the enthusiastic cooperation of the staff, who were committed to creating a culture of quality care, and the patients, who offered candid feedback.
"We're open to hearing any suggestion," Gann said. "We're from the area as well. We care about our community. We take this very seriously because this is the facility for our own families."
Carmen K. Sisson is the former news editor at The Dispatch.
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