The annual Penn Medicine Quality and Patient Safety Awards provide an opportunity for teams throughout the health system to showcase leadership and innovation activities that contribute to high-quality clinical outcomes, patient satisfaction, patient safety and cost efficiency.
In 2018, the call for submissions was answered with a record-setting 166 applications. The LG Health Emergency Department and Performance Improvement teams were among the LG Health winners.
The two teams were recognized collectively with the Operational Award for their “Utilization of Lean Performance Improvement Tools to Drive Emergency Department Standardization and Sustained Process Improvement.” However, long before the award applications were accepted, the LG Health teams were hard at work implementing Continuous Improvement tools to achieve the ED’s FY18 Experience and Access goals, ultimately improving patient care.
Continuous Improvement Tools at Work
In 2018, the ED turned to the Performance Improvement team to help develop improved workflows that would support an enhanced patient experience and decrease the number of patients who left the ED without being seen.
“To identify the unmet needs of our patients, the team needed to start with an A3 to determine what we needed to change,” said Amy Sechrist, MSN, RN, nurse manager. An A3 is a problem-solving tool used to provide structure following the Plan, Do, Check, Act cycle of Continuous Improvement. The tool allows teams to identify and eliminate the root cause of a problem, without jumping to conclusions.
During the Plan phase of the A3, the team determined that one of the most impactful drivers of patient satisfaction and access to care was whether or not the patient felt they received care within 30 minutes of arriving to the ED. In response, the team developed standards of care that included sharing ongoing status updates with patients.
“We developed structured phrasing through multiple disciplines within the ED to explain that a patient’s care began upon arrival. Managing the patient’s expectations and guiding perceptions of wait times also allowed the team to provide a better overall experience, leading to increased satisfaction,” said Sechrist.
By implementing the changes, the department observed a more than 20 percent increase in patient satisfaction, in addition to decreasing by 55 percent the number of patients who left the ED waiting room before being seen by a provider.
Extending the Impact
Once the standard of care was implemented within the ED, the team began to analyze other ways to improve patients’ access to care. By partnering with the Observation and Intensive Care units to implement the A3 process, the teams mapped sequential workflows that would benefit all staff and tested the standard of work using rapid cycle experiments. Rapid cycle experiments help teams test current standards of work as well as suggested changes to ensure the workflow solves the problem.
“The rapid cycle experiments allowed us to test the standards of work and meet the needs of all stakeholders. In order to ensure that each employee understood their work, we had every employee ‘teach-back’ the standard of work and developed a skill matrix for documentation,” explained Sechrist.
“Together our teams achieved our FY18 goal of 50 percent compliance in transferring a patient from the ED to the Observation Unit in 35 minutes or less and achieved 50 percent compliance in transferring patients between the ED and ICU in 20 minutes or less.”
Looking Ahead
The ED team continues to seek areas of improvement after observing the successful outcomes of the Observation Unit and ICU A3s, resulting in partnerships with all critical care units at Lancaster General Hospital.
“Our teams conduct ongoing evaluations at the end of each shift, at huddles and during Gemba walks to continue the vital dialogue surrounding the newly established standards and to continue to improve the standard of work based on feedback from frontline clinical experts,” Sechrist shared. “We know that Continuous Improvement is a long-term commitment that engages our staff and improves the quality of care we provide our patients.”