Emergency Department Heroes

Case: 6: Emergency Department Heroes
Define and Analyze the Problem Develop, Implement, and Control Solution(s)
Background:
Lakefront Regional Medical Center (LRMC) has undergone a merger with a large health system. As a
result of the merger LRMC is required to meet key performance indicators (KPIs). The emergency
department (ED) is not meeting the target length of stay (LOS) KPI of 113 minutes. Increased LOS
can have financial ramifications on the organization as well as patient safety and staff burn out
issues. The ED LOS at LRMC is affecting the workload for ED staff as well as causing a backlog in the
lab. In addition, there are inconsistencies in ESI level assignments, patient flow, and patient wait
times. The nursing director was the first to notice and address the problem. She has included the
president of LRMC and they are both in agreement that the problem needs to be addressed.
Additional organizational members were assembled to form a project team in order to find the root
cause and solution to this problem. The project team includes Mary (nursing director and project
manager), Judith (team ED nurse manager and team leader), Leela (president and project
champion), Process Excellence Coach (strategy manager), and three functional employees that are
also part of the steering committee. All participants are in agreement that they need to work
together to find a solution. Data shows that LRMC needs to reduce its LOS by 46.9% in order to
meet the target.
Future State:
The ideal future state is where the emergency department meets or exceeds the goal of a length of
stay of 113 minutes or lower. The success factors will include the length of stay, patient satisfaction,
emergency department staff satisfaction, and cost efficiency in emergency department operations.
Problem Statement:
LRMC is not meeting the target for ED LOS that is required as a KPI. The current LOS is 213 minutes
and the target LOS is 113 minutes.
Current State:
LRMC is not meeting the target LOS of 113 minutes for ED. This target is a required KPI.
Data supplied shows that for the months of February, March, and April, LRMC is well above the
target LOS for the ED.
Identify, Test, and Implement Countermeasures
What will be done to test and validate those countermeasures? (Think quality improvement cycles).
Countermeasure #1: optimize staffing schedule
Countermeasure #2: align processes, such as ESI levels for day and night shifts
Countermeasure #3: See patients based on prioritization
Implementation Plan:
Item What Who When
Align processes Reconcile medical and
nursing care processes
for assigning patient
aquity during day and
night shift to ensure
Nursing Director
Medical Director
Immediatley
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fast-paced attention to
patients
See patients based on
prioritization
Ensure that providers
see patients based on
coded acuity levels
Nursing Director
Medical Director
Immediateley
Staffing Schedule achieve staffing
productivity and
efficiency by grouping
days of the week based
on high, average, and
low volume to ensure
staffing aligns with
demand
Chief Operations
Officer
Immediately
Problem Analysis: 5W2H Analysis
What? Lakefront Regional Medical Center (LRMC) Emergency
Department is not meeting the target KPI for ED length
of stay (LOS). The team must come up with solutions on
how to decrease the avg ED LOS from 213 minutes to
113 minutes.
Where? Lakefront Regional Medical Center (LRMC)
When? This inefficiency has come to light post-merger with a
larger health system and introduction of new
leadership. Action must be taken immediately once the
solutions are defined.
Who? Lakefront Regional Medical Center’s Emergency
Department Staff
Why? Under the new merger with the larger health system
and new leadership, new KPIs were implemented, LOS
being one of them.
How? The staff must implement countermeasures to improve
staffing, process alignment among staff, and patient
prioritization.
Measure and Control Improvements:
Primary Metric Baseline Target Current
Length of Stay (LOS) 213 minutes 113 minutes 213 minutes
Define operational effectiveness:
– Fast-paced patient response among nursing and medical staff
– Optimal staff on schedule
Follow-up & Lessons Learned:
What issues remain that need to be closed? What worked? What could be improved?
The lesson learned in this case is that optimizing processes, such as ESI level assignment and
prioritization can significantly enhance healthcare provision, and improve patient outcomes.
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How much? The current LOS is 213 minutes and the target LOS is
113 minutes.
Zachary Pruitt, PhD, MHA, CPH; Candace S. Smith, PhD, RN, NEA-BC; Eddie Pérez-Ruberté, MS © Springer Publishing Company, LLC
Healthcare Quality Management: A Case Study Approach