Tuesday, January 5, 2016
Members of the Johnson County Community Hospital ED care team include (left to right) Lisa Brown, RN; Anne Morrow, RRT; Amy Phillips, LPN; Susan Whitener, RN; Lindsey Yoggerst, RN; and Joshua Puhr, MD.
Emergency department at JCCH becoming one of the most efficient in the region
MOUNTAIN CITY, Tenn. – When measuring the success of an emergency department in any hospital, a couple of things are easy to assess – the amount of time it takes to see a doctor and the total amount of time it takes to get treated and released.
In the hospital world, they call it “door-to-doc” time and “door-to-door” time, and they are both metrics that affect patient satisfaction significantly. Johnson County Community Hospital’s emergency department has been excelling at these metrics for months, making it one of the most efficient emergency departments in the region.
The Center for Medicare and Medicaid Services (CMS) defines the top 10 percent or top decile in these measures as being 13 minutes for “door-to-doc” time and 96 minutes for “door-to-door” time. Over the last six months, the average wait time to see the doctor in the emergency department at JCCH is only 8 minutes and the average time to be treated and released is 81 minutes, making Johnson County Community Hospital’s emergency department one of the top-performing departments in the country in terms of wait times and length of stay.
Achieving these kinds of results does not happen by accident or just good luck. Over the last year, there have been several intentional changes to the way the emergency department is run and to the processes that are performed every day. Specifically, back in June, the emergency department, managed by Susan Whitener, held a rapid improvement event, a regular process that hospital departments go through in an effort to continually improve operations.
During this event, in an effort to reduce waste and improve the overall patient experience, emergency department team members examined every step that a patient takes from the time the patient comes in the door to the time they are discharged. The result was implementation of “standard work” for every step and requires the full engagement of every member of the ED.
“Team member buy-in was crucial to the success of our project,” said Whitener, “and most all of our team members have embraced the idea of streamlining the ED visit, while at the same time providing top-notch quality care. It has even become a competition of sorts among some of the providers and various shifts.”
This competition has certainly bred success.
Whitener is quick to point out that this is not just about improving time metrics. “The ED care team standard work aims to not only decrease ED length of stay, but also balance staffing workload distribution while increasing patient satisfaction. This in turn will ensure the success of our hospital and foster community support.”
Priscilla Hicks, RN at JCCH, echoed those sentiments.
“At JCCH we have always had the patient’s best interest at hand, from the time they are greeted by our fabulous admitting staff until the time they are discharged. But ever since we completed our RIE, our team is more efficient with the care we give and the patient is able to be discharged in a timely manner. Many of our patients have commented on this and are proud to use us as an ED.”
Part of the difficulty in running a well-organized and prepared emergency department is being prepared for the varied conditions that could present themselves. The ED at JCCH treats a variety of patients with a wide range of illnesses. Some of the more common include respiratory conditions (asthma, pneumonia, COPD), cardiac events (congestive heart failure, chest pain, heart attacks), abdominal pain, kidney stones, cellulitis, various degrees of trauma (lacerations, fractures most common), dental pain, headaches, back pain and behavioral health issues.
They also see patients with seizures, stroke, stroke-like symptoms and burns. JCCH treats a large number of children, presenting with fevers, sore throats, otitis media (ear infection) and gastroenteritis being the most common.
“As a critical access hospital with the next-closest hospital 30 miles away, we have to be ready to treat whatever walks through the door,” Whitener said. “Not only do we have excellent physicians, we have some of the best trained nurses, all certified in advanced cardiac life support, pediatric advanced life Support and neonatal resuscitation protocols. Several nurses also have advanced certifications in trauma nursing, emergency pediatrics and are certified emergency nurses. We have the ability to treat and stabilize those more critical patients who need transferring to a higher level of care.”
Chastity Trivette, hospital administrator and director of ancillary services, recognizes the efficiency of the ED and the importance of it.
“The emergency department is definitely one of many things we are proud of here at Johnson County Community Hospital,” Trivette said. “We truly see it as the ‘front door’ of our hospital and many times it is the only experience that this community will have with our hospital. Susan and her team understand that, and they do an excellent job of welcoming our patients, making sure they get the highest quality care, and getting them back to their lives as soon as possible. We truly believe we have one of the best emergency departments in the region and it is something this community should be very proud of.”