ED-centric approach earns hospital award
Doctor brings different philosophy to board
Having an ED physician as its president might not have been the only reason that Aurora BayCare Medical Center in Green Bay, WI, became the first U.S. hospital to be verified as an emergency center of excellence, but it sure didn't hurt. Aurora BayCare recently received the award from Emergency Excellence (EmEx), a Chicago-based company specializing in ED benchmarking.
"This guy is primarily responsible for making things happen," says Tom Scaletta, MD, president of EmEx, referring to Paul Summerside, MD, FACEM, MMM, past president of Aurora Baycare and now chief medical officer of Baycare Clinic, a multispecialty facility that includes an ED. "Here's a mind that knows emergency medicine, trained in it, worked as a pit doctor, and rose to become an administrator," Scaletta says.
Scaletta, who also is past president of the American Academy of Emergency Medicine and chair of the ED at Edward Hospital in Napierville, IL, says, "He found himself in a setting where the hospital was not really valuing emergency medicine, and instead of caving in and putting up with it like so many of us do, he and some other docs got the financing, built a hospital, and ran it the way it should be run."
Eligibility for the award is based on the results of more than 100 key performance indicators linked to seven "pillars" of excellence (safety, satisfaction, space, staff, support, systems, and solvency). EmEx collects benchmark data and surveys physicians, nurses, hospital staff, medical staff, and administrators. The award is verified after an on-site assessment.
Summerside says the "space" pillar was one in which Aurora Baycare excelled. The ED was designed by emergency physician administrators and built to their specifications, he says. "I was president of the board at the planning and construction phases, and as an ED doctor, we were able to sell the message that the ED is the front door to the hospital and as such we should put our best foot forward with each and every patient," says Summerside. The design of the ED includes the following:
- A relatively small (15-20 seats) waiting room. "We feel it's unacceptable for people to wait," says Summerside.
- A well-appointed triage area. Throughput is designed in a circle. The patient enters one door, moves around the ED, and comes out another door. The nursing station is centrally located with no barriers, walls, or cubicles between patients and nurses.
- Separate facilities for grieving. One entire room is set aside from the rest of the ED and has a separate entrance for family. The morgue also is accessible to that room. "When deaths occur, it is tremendously disturbing to all the ED patients and staff," Summerside explains. "We wanted to move that function out of the ED as much as we could."
"Systems" was another pillar noted by Summerside. "Having managed EDs in a number of hospitals, the difference here is that we are able to make the ED problems everyone's problems," he says, "We have brought that mindset to bear in solving problems."
Consequently, the facility has excellent throughput times in labs, diagnostics, door to cath, and others, Summerside reports. "We are not the last people to get staff or service from the CT or lab," he says. "The X-ray is right in the ED, and we designed the entire radiology suite about 25 feet from the ED door so all advanced diagnostics are virtually within the ED from an accessibility standpoint."
While Aurora Baycare did not have the highest score for every indicator, their overall score was the best. Based on EmEx's system, that meant the lowest score. So, for example, their value for "admit decision to depart time" was 60, which was the best score of the benchmarked EDs. A score of 150 was considered notable, and 120 was the excellent threshold. On door-to-doc time, order-to-blood collected time, and order to ankle X-ray time, Aurora Baycare also was tops. In door-to-triage time, its value was 5, while the best score was 2. In order-to-troponin time, its value was 23, while the best score was 21.
When problems arise, leaders of different departments discuss them, Summerside says. "Our philosophy is that when the ED sits down and talks to the lab manager, it is not acceptable in our culture for the lab manager to say that is not his problem," he says. "The management philosophy is that it must be solved. In other EDs I've managed, failure has always been an option."
Business excellence is a key benchmark The "business excellence" concept exemplified by the Malcolm S. Baldrige Award was the model used by Emergency Excellence (EmEx), a Chicago-based company specializing in ED benchmarking, in setting the standards for its emergency center of excellence award, says Tom Scaletta, MD, president of EmEx, past president of the American Academy of Emergency Medicine (AAEM) and chair of the ED at Edward Hospital in Napierville, IL. "It applies to any business," he says. "You figure out what you want to benchmark, you do the benchmarking, and then you constantly try to improve upon your results. Each one represents one tiny goal for the ED team." Once these goals are set, the staff become competitive, he says. "Shifts start to compete against each other, and then the hospital across town competes with you, and the aggregate of all this is an award," Scaletta says. "That's where people really become competitive." The idea for the award came out of the 1996 IOM report Too Err is Human, issued when Scaletta was president of AAEM. "I decided to partner with Dr. Mark Reiter, [CEO of EmEx], and we looked at all the published benchmarks in emergency medicine and whittled it down to the 100 we thought were most important, and then added some novel ones we created," he says. "The goal was to develop something that would not just study problems, but solve them." |
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