Provena Improves ED Performance Through Computerized Measurement and Reporting

With over 40,000 patients visiting their 22-bed emergency room annually, a number growing by 3,000 patients each year, overcrowding is one of the leading concerns at Provena United Samaritans Medical Center (Danville, IL). But according to Nicole Boose, director of emergency services, the innovative use of reporting and measurement features inherent in MEDITECH's Emergency Department Management solution has enabled the organization to overcome many of these challenges and meet department goals of lower wait times and higher quality care.

"Our goal has been to reach the 75th percentile for patient satisfaction in the ER," says Boose. "When we first started our improvement efforts back in 2004, we were in the 3rd percentile. Our processes were so manual, we couldn't even accurately measure our average length of stay. We've come up by over 50 points since then, by holding our staff accountable for care delivered and using the MEDITECH system to store data on performance. I.T. has been been a critical tool for us in this effort."

Targeting Areas for Improvement and Monitoring Progress
One of Boose's first tasks was to identify areas critical to the Emergency Department's performance in targeted areas and to impart mechanisms for monitoring progress. "Without concrete measurements in place, we would never know whether the changes we instituted were working," says Boose.

For example, after activating the call back reminder function in Emergency Department Management, Provena United Samaritans created a MEDITECH report to track both the entry of call back reminders for discharge calls and the effectiveness of these reminders. "Initially, we noticed an unexpectedly high completion rate of calls. But after a more thorough investigation, we found many doctors were marking calls as completed in the system without actually reaching the patient. Without our report, it would have been much more difficult to identify and resolve this issue," says Boose.

Having logs and reports generated from the MEDITECH system also helped Provena to manage and motivate staff. "In combination with other survey data, we discovered discharge call completion can improve patient perception of care by as much as 60 percent," says Boose. "This information helps us to motivate staff by providing a reason behind putting in the extra effort and reinforcing the difference it makes."

In performance review situations, concrete report statistics can also help back up statements in reviews so evaluations do not seem arbitrary. "Provena has implemented an hourly rounding policy for nurses in the Emergency Department," says Boose. "Along with a rounding assessment, we developed a rounding report to log the total rounding assessments completed in a given time period. Now, in nurse performance reviews, we can cite concrete report statistics to highlight individual effectiveness or deficiencies in this area."

Indicators Shorten Patient Stays and Facilitate Troubleshooting
Provena has also made extensive use of indicators and color highlighting on the Emergency Department Patient Tracker. "An indicator on our tracker turns green when blood cultures are received in the Laboratory. Nurses can see this information on the tracker and no longer have to go back to the patient and ask whether blood has already been drawn," says Boose. "This saves time and also improves patient perceptions." Other indicators include pain score, assigned provider, assigned nurse, and pain score.

These indicators have also helped the site to improve patient management. The Length of Stay indicator on the Provena United Samaritans tracker turns red when a given time limit has been exceeded, thus helping the ED staff to manage potential crisis situations. "When my staff calls me with overcrowding issues, I can remotely access the tracker from home and help them get patients moving while sitting in my living room. The indicators on the tracker help me quickly get a sense of the current situation in the ED, and make adjustments as needed." says Boose.

The Future: Continued Improvement and Progress Monitoring
In the future, Boose hopes to continue this positive trend of increasing patient satisfaction by using the full power of the MEDITECH system. Items on the horizon include a new more efficient departure process and a complete "closed loop" medication reconciliation process, as well as physician order entry.

"The main lesson we have learned is to continue monitoring performance regardless of the changes implemented," says Boose. "This way, no matter what happens, we can always identify and overcome barriers to achieving our service and operational goals."