How 3 hospital EDs benefit from virtual beds
The following are examples of results achieved by several clients of California Emergency Physicians/ MedAmerica (CEP/MedAmerica), a Laguna Hills, CA-based emergency physician management company, who use the Rapid Medical Evaluation (RME) process. The RME process takes patients who potentially can be discharged quickly, puts them in a room, examines them, then discharges them or puts them back in a waiting room after minor ancillary testing has been done.
• Regional Medical Center, San Jose, CA: Winner of CEP "ED of the Year" award for 2005. San Jose has a 34-bed ED and a six-bed urgent care center. Volume increased from 40,000 in 2004 to an estimated 60,000 when they merged two HCA hospitals. Obtained Level II Trauma facility designation. Implemented RME in December 2004. Ranked top in CEP comparison to other high-volume sites (more than 4,000 patients per month). The percentage of patients who left without being seen (LWBS) decreased from 7% to 1%. Diversion time is down from more than 60 hours to four hours monthly.
• Madera (CA) Community Hospital: Received the CEP award for operational excellence. Madera has 16 ED beds and 21,000 annual ED visits. Volume has increased to greater than 26,000 visits annually. Their admit rate is 13%. They decreased time to physician from 34 minutes (in January-August 2004) to eight minutes (in January-August 2005). This time is down from the estimated time to provider of more than 60 minutes prior to October 2003 when CEP was awarded the contract. Madera ranks first for lowest time to physician in CEP for 2005.
Madera was the site with greatest improvement after RME implementation from January-August 2004 to January-August 2005, a 37% decrease when door-to-doctor time dropped from 34 minutes to under 10 minutes. They decreased throughput times for discharged from greater than 175 minutes to below 120 minutes. On a scale of 1-5, with 5 being the highest, they increased patient satisfaction from 3.96 in 2003 to the current high of 4.28. The percent of LWBS since CEP awarded contract decreased from 4.2% in quarter four of 2003 to an average of 0.657% in 2005.
• Riverside (CA) County Regional Medical Center: Riverside received the CEP site award for performance improvement excellence. It is a county teaching facility and designated Level II trauma center. The ED treats approximately 75,000 patients per year.
In 2004, Riverside reduced the time to provider from more than 100 minutes to under 40 minutes. The volume increased more than 1,000 patients per month that year. In 2004, the percent of LWBS patients dropped from 5% to 1.5%. The initiatives included implementation of RME, including wireless bedside registration, a redesigned chart flow system, and improved communication with use of wireless phones. Riverside used its residency program and collaborated with attendings to implement a RME program. It creatively identified new patient areas that increased treatment locations from 38 to 70.
This step was accomplished through eliminating the fast track, using chairs for low-acuity patients, etc. Patient satisfaction improved, on a scale of 1 to 5, from 3.67 in fall 2004 to 4.17 in fall 2005. In a physician/nurse survey, conducted in fall 2005, on a scale of 1-5, survey participants rated overall atmosphere and sense of team as a 5, and they rated physician awareness and physician participation and support as a 5 (4 for MD value and respect). In a survey, hospital administrator rated overall performance as a 5.
The following are examples of results achieved by several clients of California Emergency Physicians/ MedAmerica (CEP/MedAmerica), a Laguna Hills, CA-based emergency physician management company, who use the Rapid Medical Evaluation (RME) process.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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