Developing an ED process improvement plan that will work in 13 hospitals

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Emergency Services

Tara McCoy
Management Engineer
HCA - East Florida Division

With 13 emergency departments to improve, one management engineer, and lots of data, HCA's East Florida division was tasked with developing a process improvement approach that will work across their hospitals regardless of volume, layout, or acuity. This presentation explains the methodology and provides results and lessons learned from initial projects.

When HCA's East Florida division focused on dmergency department process improvement, their approach had to be applicable to hospitals of various sizes and operating characteristics. For instance, Raulerson Hospital has 21,000 ED visits per year, while JFK Medical Center has 60,500. A successful approach had to examine each point in the ED flow that could delay a patient using standard data and tools.

The final result was a project plan which broke the ED process into seven steps:

  1. Arrival to triage
  2. Triage to bed
  3. Registration
  4. Lab turnaround
  5. Imaging turnaround
  6. Bed to disposition
  7. Admitting patients from the ED

The plan required the formation of a multidisciplinary process improvement team with management engineering support and an administrative champion. This group will flowchart, perform data analysis, and develop ideas for improvement on each of the seven processes listed above. The HCA ED Dashboard was used to standardize data analysis on the seven processes and for continued monitoring. This approach was piloted at Northwest Medical Center where the percentage of patients who left prior to treatment was reduced from 6.9 to 2.8 percent and Plantation General Hospital where the percentage of patients who left prior to treatment was reduced from 12.9 to 7.2 percent.