March 31, 2017

How one hospital cut ED hold hours by nearly 80 percent

Daily Briefing

    To combat overcrowding and unnecessary visits, Sunrise Hospital & Medical Center integrated its ED physicians and hospitalists—with dramatic results, Matt O'Conner writes for Hospitals & Health Networks.

    Sunrise serves as one of Nevada's largest Medicaid providers, and after the implementation of the Affordable Care Act, as well as the state's decision to expand Medicaid under the health care law, the hospital saw the utilization of its ED services increase by double-digits. According to Alan Keesee, Sunrise's COO, the hospital reported 157,000 ED visits in 2016—the largest number in the state—and more than half of those visits were from Medicaid beneficiaries.

    Sunrise was also struggling with hold hours in its ED, Keesee said. During its most difficult month, Sunrise experienced 28,000 hold hours—8,000 more than its monthly average. 

    One team, one culture

    To tackle the problem, Sunrise integrated its ED and hospital medicine teams under one medical director. As part of the integration, Sunrise recruited additional providers, developed team-based models for observational patients, and streamlined processes to move patients out of the ED and to other parts of the hospital more quickly. 

    For instance, while most hospitals have their observational patients spread throughout a facility, Sunrise created a separate, 30-bed observation unit, staffed by a dedicated team of providers and case managers.

    According to Keesee, the changes have:

    • Helped increase the number of patients discharged prior to 11:00 am from 10 to 50 percent;
    • Contributed to an overall one-day decline in patients' length of stay; and
    • Cut hold hours in the ED to 6,000 hours per month—a 79 percent decline. 

    There's also been a noticeable shift in care and culture, with a particular increase in nurse-physician collaboration, Keesee said. Nurses are made aware of who is staffing the care team each day, which facilitates communication, and the focus on shared goals has generated more trust across the care team.

    Keesee said after the integration, leadership is continuously trying to improve the process. "You can't do that in a silo, just the ED, just the hospitalists, you have to really have all those voices at the table, to make improvements (and) continue to move forward," he said  (O'Connor, Hospitals & Health Networks, 1/27).

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