This article appears in the September/October issue of Surgical Products.

The goal of every hospital emergency department is to provide quality care in an efficient manner or quickly direct patients to another area of the facility to be treated.

However, doing so can be a tall task for many hospitals, especially those without the means to accurately assess efficiency in the emergency department and without the tools to improve visibility and communication between staff members throughout the facility.
For St. Rita’s Medical Center, located in Lima, Ohio, a 2011 emergency department renovation project led hospital administration to develop an initiative to address efficiency concerns, improve wait times, and increase patient satisfaction within and around the emergency department.
To do so meant changing the staff’s approach and mindset toward patient demands for healthcare in the emergency department.
“It wasn’t really an objective view,” says Robb Recker, RN-BSN, MBA, and Director of Emergency Services at St. Rita’s. “That created some challenges because it was more of a gut feel kind of thing than a black-white kind of thing.”

Emergency department patients at St. Rita’s sometimes waited hours to be treated. Even worse, the hospital had no effective means of quickly reacting and responding to the ever-changing demand for treatment by patients in the emergency department. Hospital officials determined the best course of action was to develop a way to alert and update the entire staff about the demand for care in the emergency department, allowing them to respond quickly and appropriately.
To accomplish their goal, St. Rita’s implemented its National Emergency Department Overcrowding Score (NEDOCS) program in January of 2013. A national standard for calculating hospital capacity and crowding, NEDOCS are calculated by comparing the number of beds available in a facility to the number of patients in high acuity care areas to the number of patients waiting on a hospital bed or services. A registration or clerical staff member takes the data from the patient track board, plugs it into the NEDOCS calculator, and gets a score in a matter of minutes. That information is then recorded and analyzed regularly.  The facility began calculating its scores every two hours, and employed its communications platform to alert all clinicians in the hospital when the emergency department became overcrowded so they could help if ready and able to do so.
“It gives us a very objective view of how crowded or overcrowded are department is,” says Recker.

Thanks to the combination of an improved communication process and easy access to accurate data, St. Rita’s staff knows that when the NEDOC score is high, patients are experiencing much longer wait times, and this can become extremely frustrating for them and eventually cause them to walk out. Prior to the program’s implementation, there was no way to let in-house clinicians know that staff was struggling to meet patient demand for care in the emergency department.

“Today, we’ve broken down the communication silos that previously existed between our ED and the rest of the hospital – and we’ve successfully reduced both wait times and walk-out rates,” says Jodi Pahl, the hospital’s chief nursing officer.

“It has allowed us to see trends by hour of the day to see when we get to full capacity,” says Recker. “But really what I think it has shown is when we get to that severe level, we’re not in it for an extended period of time.”

According to Recker, the staff can react, address issues in the emergency department, and resolve them in a matter of a few hours thanks to the communication platform, which sends a text message of the severity score to all clinicians and the administrator on call. The hospital has actually employed the communication system for more than five years, but was able to use it in concert with its NEDOCS program to effectively address its efficiency issues in the emergency department.
For example, Pahl points to one fairly recent Friday evening where the facility’s recent efforts to deal with patient wait times paid off: The emergency department hit “red level” and a text message alert was sent out. Available physicians and nurses were able to help the emergency department staff by working with patients they knew were going to be admitted and funneling them to the right care areas within the hospital, which meant the emergency department staff could focus on the patients that truly needed emergency attention, which quickly led to a decrease in wait times for patients in the emergency department.

“We started using it with physicians, but now we have branched out to use it with multiple teams,” says Pahl, noting that those include rapid response, trauma, stroke, among others.
“Everyone’s buy-in was very well received,” she continues “We’ve had no difficulties in really wanting to get patients and pulling those patients up to the unit. It has really been a team effort.”

Ensuring emergency department efficiency is now a facility-wide effort at St. Rita’s, and it has allowed the hospital to respond to patient overflow in that area more rapidly and more effectively than ever before. This has led to reduced wait times and improved patient satisfaction.