Have you ever wanted to see at a glance how your ED is improving in various areas — or identify the worst problem areas? At Southern Ohio Medical Center in Portsmouth, a "Balanced Score Card" is used to gauge the operational health of the ED.
"This gives you a tool to track and trend change, measure both short- and long-term objectives, and communicate with physicians, nursing staff, and hospital administration," says Mary Kate Dilts, RN, MSN, director of nursing for emergency and outpatient services. Here are benefits of using a score card tool to track ED operations:
• It allows you to benchmark.
The score card enables Dilts to measure her ED against national benchmarks for the following areas:
— Number of patient complaints. The ED uses data from the Dallas-based American College of Emergency Physicians to compare the number of complaints per 1,000 patient visits.
— Patient satisfaction. South Bend, IN-based Press, Ganey Associates Inc. is used to collect patient and employee satisfaction data.
— Delays. Data are used from the Clockwork ED Series on Eliminating Bottlenecks and Delays, developed by the Washington, DC-based Clinical Initiatives Center, a membership-based health care organization that performs research for more than 1,500 hospitals. (For more information on the Clockwork ED series, see "Study offers solutions for bottlenecks: Treat and move patients in record time," ED Management, March 2002, p. 25.)
— Door-to-drug time for thrombolytics. The ED compares its data with the National Registry of Patients with Myocardial Infarction, sponsored by South San Francisco, CA-based Genentech, which has collected data on more than 1.8 million acute myocardial infarction patients.
Dilts says the ED’s door-to-drug time was 80 minutes in 1996 and currently is 15 minutes. This achievement, she says, was made by cross-training ED technicians to draw labs and perform electrocardiograms, and collaborating with the pharmacy for the stat preparation of thrombolytics. "Our data now exceed the benchmarks for both . . . Ohio and the United States," Dilts says.
• Delays are reduced.
Although the ED’s census has climbed from 32,000 in 1998 to 52,000 currently, delays are reduced or stable, which Dilts credits to use of the score card. "I’m convinced if we hadn’t been paying attention to it, we would be in a very difficult situation today," she says.
The ED has dramatically reduced average door-to-doctor times from 100 minutes in 1996 to only 40 minutes with the use of bedside registration, she adds. The switch started off with only 35 uses of a wireless computer, but within a year increased to 1,400 uses, and it is now at more than 3,000 uses per quarter, Dilts says. Average throughput time decreased by 30 minutes since the score card was implemented, she adds. (See graphs depicting the ED’s use of bedside registration and average throughput time, below.)
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The score card helped with this endeavor, she says. "We were putting data out in front of people every month, and reminding staff that this is a decision we made based on the needs of the patient," she says.
• Celebrating achievements boosts morale.
Tracking the results from the score card is a morale boost for nursing staff, Dilts says. "It becomes fun, throwing out a different goal every month," she says. When the stated goals are achieved, the staff are rewarded, says Dilts. For example, when the number of patients registered at the bedside reached several hundred, staff had a ribs and chicken dinner. Staff occasionally receive tokens with a $5 value or 5 points, with 90 points equaling a day off with pay. Recently, every staff member received a letter with a 99 cents coupon for a fast-food restaurant as a reminder of the ED’s goal to achieve the 99th percentile for patient satisfaction.
• Staff are kept apprised of problem areas.
The score card is available on the hospital intranet and is posted on the ED bulletin board every month, Dilts says.
Armed with this knowledge, staff enthusiastically target goals they can directly impact, according to Betsy Marsh, RN, assistant nurse manager of the ED. Feedback provided by the score card allow staff to see how their actions directly impact the results, Marsh says. "When the scores improve, the staff are motivated to keep working harder to achieve more." Likewise, when the numbers slide a little, staff become more creative in finding ways to get the scores back up, Marsh says. For instance, when patient satisfaction data were compared between day and night shifts, the night shift scores were significantly lower.
"The staff created hot blanket night,’ and cold drink night,’ with staff making patient rounds," Dilts says. "Their scores jumped!" Currently, the ED is planning staff retreats with the day and night shift nursing staff, which will include a discussion of the score card, she says. The retreat will be held on the hospital campus, but out of the ED, and will focus on trauma care and team building, she says. "The idea is to let everyone know exactly what we are measuring, so I can get 125 people rowing in the same direction," Dilts says.
Sources
For more information about the Balanced Score Card, contact:
• Mary Kate Dilts, RN, MSN, Director of Nursing, Emergency and Outpatient Services, Southern Ohio Medical Center, 1805 27th St., Portsmouth, OH 45662. Telephone: (740) 356-8430. Fax: (740) 356-6387. E-mail: [email protected].
• Betsy Marsh, RN, Assistant Nurse Manager, Emergency Department, Southern Ohio Medical Center, 1805 27th St., Portsmouth, OH 45662. Telephone: (740) 356-8165. Fax: (740) 356-6387. E-mail: [email protected].
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