When HealthAlliance of the Hudson Valley (HAHV) consolidated two emergency departments into a newly renovated, state-of-the-art, 35-bed ED at The Kingston Hospital, we set the aggressive goal of having 95 percent of the patients seen by a clinician within 30 minutes of check in.
To accomplish the objective, our three-hospital health system in 2010 implemented a comprehensive electronic health record system from EDIMS that has enabled the organization to dramatically improve ED operations and put us within a few whiskers of meeting our desired wait times. As of January 2011, 87 percent of patients presenting daily at the ED were seen within 30 minutes, up from 47 percent when HAHV launched its initiative in April 2010. Before that, the average wait time was 47 minutes, which was within the national range of 47 to 55 minutes; however, it was not acceptable for the hospital's high standards for care delivery. We are confident that we would have hit 94 percent had we not maintained a percentage of "hold" patients in the ED due to Kingston Hospital (150-beds) being at capacity for six days during January.
A key driver behind our improvement is a time stamp feature in the EHR. This function allows us to analyze the wait times from the moment each of the 150 patients we see daily are registered, triaged and placed in the room for treatment. Every morning the operations team runs a report on the previous day, briefs ED and inpatient clinical leaders, and posts performance results for clinicians to review.
Buy-in and willingness from clinicians to work as a team also have played a key role in the progress we have achieved over the past 10 months. Every ED clinician shared the goal of treating patients as quickly as possible with the best standard of care from the get-go, but getting them to adopt the EHR and to be on the same page was challenging. That's because we had to merge nurses from a secular hospital and a religious facility--that had competed with each other for years--while simultaneously introducing the EDIMS EHR and bringing in a new emergency physician staffing group.
To ease the transition for clinicians, we spent two years integrating the medical services of Kingston and Benedictine Hospitals, leaving emergency care for last. The organization also trained and educated staff on the use of EHR and wait time metrics, held regular meetings and solicited employee input on governance issues.
The results show the organization's strategies were successful. More importantly, they indicate that other health facilities are likely to have an easier time implementing EHRs to reduce ED wait times--and improve care and patient safety--because those institutions probably will not have to overcome as many issues or cultural differences as we had to.
While we are very pleased with the progress made to date, we will reset our target to 100 percent as soon as clinicians see 95 percent of patients within 30 minutes for three consecutive months. This ambitious goal, which we anticipate will occur this year, is reachable: For the week of Jan. 17, we hit 99.5 percent!
It is possible we could have reduced wait times using paper records, but we certainly could not have done it as quickly or efficiently as we were able to with the assistance of an EHR. It would take several people hours to manually analyze wait times for 250 patients compared to the few minutes per day it takes one person to perform that task now.
Stuart Hirsch is administrative director of emergency services at the HealthAlliance of the Hudson Valley.