Recent upgrades to the Emergency Department at Regional Medical Center at Memphis were featured in an article in Memphis Medical News.
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TRINA L. JONES
A streamlined ED at The MED
With its Level 1 Trauma designation and four distinct Emergency Department units – trauma, labor & delivery, burn and medicine – emergency services are a major business driver for the Regional Medical Center at Memphis (The MED). They account for 80 percent of the public hospital’s inpatient volume, and improving the ED’s environment and processes has been a key focus for The MED over the last two years.
Pam Castleman, MSN, came to The MED as a trauma director in 1995 and was named chief of nursing/senior vice president in 2010, when The MED’s newly named CEO, Reginald Coopwood, MD, came on board. Coopwood’s vision to make The MED more competitive in the Memphis medical marketplace and to stabilize its financial foundation has been an impetus for the transformations in the Emergency Department and the entire hospital over the last two years, Castleman said.
“Overall, The MED has become more streamlined and focused in our core business units,” she added. “Of course, emergency services is a big area for us, and a specialized function that we provide for this region, so we paid a lot of attention to improvements here.”
One of the biggest improvements is immediately seen in an $800,000 renovation that was completed in 2011 on the hospital entrance and Emergency Department off Jefferson Avenue. Patients and visitors notice a dramatic change as soon as they go into the hospital, Castleman pointed out. “The Emergency Department is far more inviting and welcoming, less confusing. It’s also important for people to feel secure, so patients and families see friendly security guards at the station as they walk in, then see the marked Triage Welcome Center immediately. They have a pleasant environment to wait in.”
In addition to the flow redesign, new furnishings and updates to décor, physical improvements also included internal and external signage for better wayfinding, eradication of parallel parking on Jefferson Avenue to allow for safer pedestrian traffic, and streetscape/landscaping improvements.
Improvements to make better first impressions for patients was very important, but of equal concern was making improvements to ED processes, Castleman said. “Our emergency patients are recipients of what we call a ‘pull process.’ That means we are designing our processes to get the patient to the bed or to the services they need as quickly as possible. Before, the patient would have spent hours waiting at different steps of the process. Now, our goal is to get them back to the treatment area, get them through triage, then handle the rest of the registration process. What happens is that the patients feel like they are moving, that the process is working for them, and they don’t feel stagnant in the system.”
According to Castleman, several factors are affecting The MED’s process flow improvements in the Medical Emergency Department, including the use of Computerized Physician Order Entry (CPOE). “Nurses have been using the electronic medical record for quite awhile, but adding physician order entry gives us faster input and implementation of orders for labs, tests, medications and procedures. Once back in the treatment areas, everything is on a tracking screen that gives the staff a constant visual of where the patient is on the treatment continuum. This automation really provides a more streamlined and timely process for the patient.” A bedside registration process is another step in streamlining the Emergency Department experience, she added.
Another feature designed to improve the patient and visitor experience is implementation of a new voice communication system. “Soon we will be rolling out a voice communication device that everyone on the team wears. They’ll push a button on the device and talk into it to communicate with others on the team. You won’t be hearing all those paging announcements on the overhead, or calling out in the hallway. That means a quieter ER for everyone.”
Changes geared to quieter, more pleasing environments are part of The MED’s goal to be more family-centered. “Family is important to the patient’s healing process, and in all of our renovations in the ED and throughout the hospital, we are making changes to accommodate features for family comfort and convenience. As we renovate each unit, we are making sure to focus on the family space, as well.”
As HCAHPS (Hospital Consumer Assessment of Healthcare Provider and System) scores become a more crucial concern for hospitals, The MED is constantly assessing its improvement opportunity areas, Castleman said. “Like every other hospital, we have challenges and struggles with some areas. The Studer Group is with us right now and will be focusing on several initiatives, including work in the ED. Our Emergency Department HCAHPS scores have improved since the renovations, and the work we’ve done on our processes to improve patient throughput has also been a factor (in improving scores).”
Also impacting The MED’s ED treatment capacity has been an increase in physician coverage and the introduction of nurse practitioners and physician assistants to the staffing mix. Nurse practitioners work in the ED’s fast track area and handle the minor cases that come into the medical Emergency Services area. Providing three distinct areas of treatment – fast track, urgent care and Level 1 medical cases – is another process change that was implemented to decrease patient wait times and improve treatment turnaround times in the medical ED, Castleman said.
Over the last five years, total patient volumes in The MED’s Emergency Department units have been declining, going from 60,200 visits in FY2007 to 45,189 in FY2011. If The MED is getting patients to the appropriate place for medical services, that trend is going in the right direction, Castleman said.
“If we are successful in our efforts to educate patients, and to get them to the appropriate level of care, such as primary care services offered through our four Health Loop Clinics and MedPlex, we may continue to see declines in ED volumes. We’ve expanded hours in our primary care clinics and have instituted Saturday hours. We’re not trying to discourage people from using the ED when they need it, but we are trying to educate them about the primary care locations where they can get appropriate follow-up care, and where they can establish a relationship with a primary care provider in their neighborhood.”
To help move people to the most appropriate levels of care, The MED soon will be implementing the Studer Care Management System, which includes a callback system to track patients after they’ve left The MED. Patients will be called to see if they have kept their follow-up appointments, or will be assisted in getting other appointments or services scheduled.
”The MED is trying to be that full-service option for the patients who come to us. The ER may be the first experience you have with us, but we want you coming back to The MED for all your medical service needs,” Castleman said.