Success Stories

Improving Patient Flow and Workflow at a Tertiary Care, Teaching and Trauma Center

Rhode Island Hospital’s emergency department treats over 100,000 patients a year in a 100 bed department. The main teaching hospital for the Brown University Alpert School of medicine, the department had many of the challenges typical for these departments. Determined to improve its efficiency the ED leaders engaged Quality Matters consulting and set out to re-engineer patient flow with four simultaneous improvements:

  1. Physician in Triage
  2. Fast Track
  3. Vertical Flow for Middle Acuity Patients
  4. Immediate Ambulance Bedding

The results were astonishing! The ED Leadership won the coveted Quality Award that year.

Door to Doc 52 minutes 22 minutes
LOS Discharged 297 minutes 228 minutes
LWBS 4.63% 1.89%

Physician Coaching Project

A physician in a large group practice had fallen behind in documentation, productivity and the clerical elements of his work. Lab approvals and authorizations needed attention, dictation summaries for referring doctors and the charting necessary for insurance pre-authorizations were all in a backlogged state. According to the CFO there were concerns that his coding distribution was aberrant relative to his colleagues. According to the Chief Quality Officer he was late for his clinic every day while running a very disorganized practice. His productivity was half that of his colleagues. Yet he was a wildly popular physician in the practice and much loved by his patients and they wished to retain him in the practice. After a three month coaching project including an assessment, the development of a work plan and the introduction of many improvement strategies this physician is on time and up to date in all areas. In addition, the practice at large benefitted from many of the improvements suggested.

Physician Leadership Mentoring Project

A medical director for a clinical unit was struggling with leadership duties. He threw his department into chaos by regularly attempting to introduce new innovations without properly managing the change. He was not delivering on many of the quality and safety items required in his contract. The CEO anticipated replacing this physician but he was in many ways a natural born leader and well respected and admired by the medical staff. A 6 month peer to peer coaching project with special tutorials in leadership and management training and including a quality improvement module was begun. The physician was successfully able to implement many of the innovations he had tried to introduce before. The executive leadership team voted to keep the physician in his position.

Improvement in Time to Pain Management with New Initiative

A complaint from a family member over how long it took for her husband to receive pain medication when he presented with a kidney stone to the hospital ED in Salt Lake City, led to a pain management audit and initiative. The pain management audit revealed what research has shown; emergency departments do not consistently perform well in the timely delivery of pain medication in the ED. This realization led to the development of advanced triage protocols for common painful conditions presenting to the ED. In addition, staff received training and education regarding pain management. A subsequent audit showed decreased time to pain medications.

Time to Pain Management    BEFORE    67 Minutes
Time to Pain Management    AFTER    46 Minutes

Improving Door to Physician Time in Two Community Hospitals

Two community hospital emergency departments were underperforming in terms of door to physician times, in particular relative to the flagship hospital of a large healthcare organization in the mountain states. The flagship hospital boasted door to provider times of under 18 minutes consistently. An improvement project was begun which involved streamlining the intake process and reducing unnecessary steps, education and awareness of staff, using IT cueing and a feedback loop with data provided individually to physicians regarding their performance. The results were rapid, dramatic and sustained.

Hospital A, Door to Doc 51 minutes 31 minutes
Hospital A, LWBS 2% 0.8%
Hospital B, Door to Doc 47 minutes 27 minutes
Hospital B, LWBS 1.2% 0.4%