By Suzi Birz, principal, HiQ Analytics
What does it take for a hospital to compete in today’s market?
What can improve the patient experience in the emergency room? This month’s
Technology Report takes a look at how one hospital achieves a 20-minutes-or-less
standard for patients to be seen by physician in the emergency department.
“Genesis is our continual journey to care transformation and
creating better ways of delivering health care every day,” said Kevin DiCola,
spokesperson for Trinity Health, in Novi, Michigan. An integral element of
Trinity Health’s process improvement commitment, Genesis is a system-wide
initiative uniting state-of-the-art information systems with evidence-based
knowledge to create world-class patient safety, clinical quality and financial
As systems get implemented at St. Joseph Mercy Oakland
Hospital, in Pontiac, Michigan, the integration of people, processes, technology
and culture is already underway. Using aspects of the available technology and
that to come in later phases, St. Joseph is literally transforming the way the
emergency department works. One of the goals is to consistently meet a promise
of 20 minutes or less to see a physician.
The Emergency Department’s New Process
Pam Wietecha, RN, clinical leader, at St. Joseph Mercy Oakland
Hospital spoke about the changes to the emergency department procedures enabled
Designing a process to meet the “20-minute promise” took a
multidisciplinary, collaborative group including nurses, physicians and
ancillary personnel from the emergency center, registration and short-stay
A typical scenario might be as follows: A patient comes into
the emergency center. Patients with chest pain, stroke symptoms or other
apparent urgent complaints are taken directly to a treatment room. Typically,
within five minutes of arriving, patients with non-life-threatening complaints
are quickly registered, the intake process is completed and they are taken to a
treatment room. The registration starts the length-of-stay counter.
The registration system sends information to the tracking
system and places the patient in the waiting area. As the patient moves to the
exam room, the tracking system is updated. Anywhere in the department, staff can
track patients’ movement and see who is waiting.
In the new process, the triage assessment is completed in the
treatment room. The nurse and the physician will meet in the treatment room
together with the patient. This represents a change in the way the work is done.
Nurse charting has changed. Focused assessment charting is
documented in real time in the computer. Although this is a new task for many
of the staff, it has been largely well-received. As a byproduct of real-time
charting, caregivers now have the capability to look up what care has been done.
Effects of the New Process
The new process has had a number of effects on patient safety. The computer system houses information about previous medical/surgical history,
attending physicians and demographic information. The care team can retrieve
this information from anywhere in the emergency center.
Caregivers have access to a list of home medications at a
glance. The medication reconciliation process is documented and can be viewed by
the care team. Allergies, including an indication of “addressed or not
addressed” are charted. A patient’s height and weight are available for the care
team and can easily be used for medication calculations.
In the event the patient is admitted, caregivers on the
patient care unit have access to the information about the emergency department
activities and results in advance of the patient arriving on the unit. This has
the potential to prevent repeat labs and affords the caregivers an opportunity
The biggest change for the nursing staff is the arrival and
use of the technology. Nurses are now charting in the exam room on a computer.
To assist in the implementation, staff went through training sessions.
Some users were trained as “superusers.” Superusers are
available on all shifts in the emergency center. Superusers meet once a month
for training and updates to support the staff. Training manuals were distributed
to all staff in training sessions, and reference sheets were posted to help
assist with new information.
Recent evidence of success with both the caregivers and the
patients has been demonstrated. During a computer outage, the caregivers
expressed missing the system and remorse at having to complete their work with
the old tools. Patient satisfaction is also on the rise.
The goal is to meet the 20-minute promise consistently.
Barriers to achieving that promise have been identified. Inpatient bed
availability requires patients to be held in the emergency department. A rapid
influx of emergency patients and staffing can also be impediments.
Efforts will continue to remove the barriers and meet the time
commitment every time. The next big process change will come with the
implementation of computerized provider order entry.
“Embrace the technology, it is not going away; the electronic
medical record is definitely the wave of the future,” Wietecha concluded. “In
the long run it is helpful to distribute information to everyone and rapidly
Project Genesis Unites Hospital System
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