The problem/issue identified at
Nyack Hospital, Nyack New York initiated a commitment to create a 30 Minute Service Guarantee in our ER, in which patients visiting the Emergency Department will be seen by a Physician/Mid-Level Provider within 30 minutes of entry into the Hospital. Nyack Hospital launched the ER30 campaign using "At Nyack Hospital, your emergency is our emergency" as our slogan.

The approach used to address the problem or issue:

After recognizing that our patient satisfaction scores where stagnant and well below our goal to be in the 80th percentile in our peer group. Nyack Hospital retained the services of a LEAN/SixSigma expert and began the journey to becoming a Compass Award Recipient from Press Ganey.

The challenges and barriers faced:

Staffing Buy-in on the Top down/Bottom up approach took some time to catch on with skeptical staff who felt initially that this too will go away soon. With persistance of daily huddles, staff soon were on board and became active participants in applying LEAN Methodologies like piloting and measuring current workflow.

Flow:

Using departmental CAD drawings, detailed process mapping, value stream mapping and spaghetti diagrams we were able to improve the natural flow throughout the department. Visual references were powerfull tools to convince staff that changes were needed.

Architectural barriers: Due to the fact that we are working within an existing space which was designed to see 30K patients not 50K, Space re-allocation and re-design of processes became essential to the success of the department.

Budget: This project was more about re-design of work processes than spending a lot of money. In that regard, architectural and engineering intervention was checked to a mimimum. Only after successful LEAN implementation strategies were achieved, was the Architect brought in to drill down through the existing Emergency Department to flesh out available space for insertion of additional treatment cubicles and nurse work areas.


The method analysis that was used:

LEAN Five minutes Huddles, Detailed process/value stream mapping, extensive piloting of ideas, TEAM building exercises, Communications and Control, celebrating successes.

Architectural planning analysis:

Work groups with multiple disciplines, flow controls, minimal modifications to exsiting lay-outs to optimize space and efficiencies.


The conclusion or outcomes achieved and the recommendation(s) that you would offer:

Process improvement gains - Nyack Hospital went from 40th percentile to 90th percentile in peer group
Describe improvements - The Nyack Hospital ED is seeing 90% of its patients within 30 minutes of arrival, waiting room is closed, bed side registration for all patients, triage is completed by all staff rather than one designated nurse, integration of EMR, 50% decrease in Length of Stay in the ED for admitted patients from 8 hours to 4 hours, Door to EKG time < 10mins and sustained patient satisfaction >90%, less than 1% walk-outs and 25% increase in patient volume since program initiation of the 30 minutes service standard.

Metrics:

Press Ganey Patient Satisfaction scores for Emergency Room patients, patients seen within 30 minutes (%), Length of Stay (hrs), Walk-outs (%), Turn around times for diagnostic studies( min/hr).

Successful ER30 Winner of 2008 Press Ganey Compass Award for most outstanding improvements in Patient Satisfaction scores in an Emergency Department.