emergency services industry...

Emergency Services

Industry Update

Presented By: Stephanie Baker, MBA/HCM, RN, CEN

Emergency Services Senior Quality Leader May 2013

Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.

Studer Group Mission and Vision

Mission:

To make healthcare a better place for employees to work, physicians to practice medicine and patients to receive care.

Vision: To be the intellectual resource for healthcare professionals, combining passion with prescriptive actions and tools, to drive outcomes and maximize the human potential within each organization and healthcare as a whole.


About Studer Group and our ED Coaching Team

Execution company focused on

achieving and sustaining

exceptional clinical, operational &

financial outcomes

Recipient of the 2010 Malcolm

Baldrige Quality Award

Ranked #4 Great Small

Workplace in America

Recognition of multiple ED

partners with our “Healthcare

Organization of the Month Award”

Work with over 1400 ED’s in the

U.S., Canada and Australia

ED expert coaches and speakers

each with 20+ years ED

operational/leadership

experience

ED specific educational

resources such as onsite

coaching, books, training videos,

webinars and institutes

Web-based software solutions for

operational alignment and

process efficiency/ improvement

Evidenced-Based tactics that

produce:

Accelerated rate of

improvement and efficiency in

ED flow, operational metrics,

clinical quality and patient

perception of care

Improved HCAHPS results

Maximized reimbursement

Increased physician loyalty


ED Expert Coaching Team

Stephanie Baker,

MBA/HCM, RN, CEN Dan Smith, MD,

FACEP

Angie Esbenshade, MSN,

MBA, RN, CEN

Regina Shupe, MSN,

RN, CEN

Ryan Oglesby, PhD,

MHA, RN, CEN, NEA-BC


The New Reality: Current Trends in Emergency Medicine

According to the Centers for Disease Control, ED

visits in the U.S. have increased 37% from 1995 to

2011, hitting a new all time high of over 124 million

visits in 2011. That’s 222 visits per minute!

Simultaneously, the number of hospital ED’s

decreased 7% from 4,109 to 3,833.

ED volume is expected to rise 5% a year for the

next 5 years.

33% of patients spent 4-6 hours in the ED during

their visit.


Transparency Continues with CMS Reporting of ED Core Measures in 2013

Median time from ED arrival to departure for admitted

patients (door to admit) NQF 0495- Current

Benchmark = 274 minutes (4 hours and 34 minutes)

Median time from ED arrival to departure for

discharged patients (door to discharge) NQF 0496-

Current Benchmark = 139 minutes ( 2 hours and 19

minutes)

Median time from ED admit decision to departure for

admitted patients (dispo to admit) NQF 0497- Current

Benchmark = 96 minutes (1 hour and 36 minutes)

**Data pulled from Hospital Compare website as of 4/22/13 and represents 3500+ ED’s


Leadership in Healthcare

Being a leader in healthcare today is

like continuously walking up a down

escalator.

If one stands still they go backwards.


“Vision without

execution is

hallucination.”

Thomas Edison



Structure Execution

Strategy

Results Triangle

Results


Consistency Reliability

Accountability

Execution Triangle


®

Healthcare Flywheel®

Bottom Line

Results

(Transparency and

Accountability)

Self-

Motivation

Prescriptive

To Do’s

Winning

Courage

Execution

Purpose,

worthwhile work

and making

a difference


ED Bottom Line Results

Service Quality People Finance Growth

Higher patient

satisfaction

Stronger

physician

collaboration

Fewer patient

complaints

Reduced:

Door to doctor

Doctor to

disposition

Disposition to

discharge times

Fewer unplanned

returns to ED

within 48 hours

Improved

HCAHPS results

in all ten

composites

Lower employee

turnover

Higher employee

Higher physician

satisfaction

Lower overtime

Lower agency

costs

Lower "left

without

treatment" rates

Higher upfront

collections

Improved hospital

and physician

revenue

Less potential for

litigation

Quicker access

to timely care

Higher patient

revenue

associated with

new flow

procedures,

Improved

community

preference for

your ED

Improved

medical staff's

perception of

the hospital


Standardization Accelerators Must

Haves® Performance

Gap

Objective

Evaluation

System

Leader

Development

Foundation STUDER GROUP®:

Rounding for Outcomes

Provider and Employee Rounding

Patient Rounding

Hourly Rounding in Treatment and Reception Areas

Thank You Notes

Employee Selection- 30/90 Questions

Key Words at Key Times - AIDETSM

Post Visit Phone Calls

Pull until Full

Patient Segmentation/Split Flow

Pillar Agendas

Skills Labs

Behavior Validation Tools

Standardized Patient Flow Processes

Leader Evaluation ManagerTM

Patient Call Manager

Rounding/AIDET Toolkits

Aligned Goals Aligned Behavior Aligned Process

ED Assessment

Expectations Meeting

Steering/Implementation Team

Goal Alignment/Create Dashboard/Monthly Performance Meetings

Strategic Goals for Return On Investment (ROI)

Rounding and Behaviors Standards

Evidence-Based LeadershipSM

Emergency Department


Driving Performance


When you know you

have a solution to a

problem that is causing

pain for someone –

you have a human

responsibility to act,

and to do so with all

urgency.

~ Quint Studer

Human Responsibility


What’s the Why?

Correlation with HCAHPS “Percent of

Patients that Rate the Hospital a 9 or 10”


As Hospital’s ED Percentile Ranking Increases,

So Does Its HCAHPS “Overall” Percentile Ranking


Percent of Patients LWBS by Hospitals Score on HCAHPS “Patients That Rate Hospital a 9 or 10”

Reflects data from >3500 ED's reporting to CMS


Median Wait Time by Hospitals Score on HCAHPS “Patients That Rate Hospital a 9 or 10”



The Longer the Door to Doc Wait Time, the Greater the Percent of Patients LWBS



Emergency Department Throughput Measures Reported by CMS

Emergency Department Throughput Measures National Average 1/1/2012-

3/30/2012

National Average 1/1/2012-

6/30/2012

Average (median) time in minutes patients spent in the emergency

department, before they were admitted to the hospital as an

inpatient (NQF 0495)

277 Minutes 274 Minutes


department, after the doctor decided to admit them as an inpatient

before leaving the emergency department for their inpatient room

(NQF 0497)



department before being sent home (NQF 0496) 140 Minutes 139 Minutes


department before they were seen by a healthcare professional

(Door to Doc)


Average (median) time in minutes patients who came to the

emergency department with broken bones had to wait before

receiving pain medication


Percentage of patients who left the emergency department before

being seen (LWBS) 1.9% 1.9%

Percentage of patients who came to the emergency department

with stroke symptoms who received brain scan results within 45

minutes of arrival

43% 45%



Sobering Reality


ED CAHPS Survey is Coming…

ED Consumer Assessment of Healthcare Providers and Systems

(CAHPS) survey development is currently underway by CMS

The “request for information for suggested topic areas” period closed on

February 1, 2013

The survey target population is ED patients (and caregivers of ED

patients) who receive Emergency Department care and are discharged

Outcome goals:

Understand patients’ perspectives of their ED visits and how these

experiences change over time

Enable objective comparisons of ED experiences across the country

Improve the quality of care patients receive in Emergency

Departments


ED CAHPS Survey is Coming…(cont.)

ED CAHPS survey field test to be conducted June-November

2013

12 hospitals to participate and have 300 completed

surveys per hospital

Testing to be by mail and phone

Goal is to survey both ED patients who are discharged

and those who are admitted (after HCAHPS sample is

pulled out).

CMS is funding the field test

ED CAHPS field test results are expected in Q1 2014

Full survey launch expected in Q2 2014

A portion of ED reimbursement is likely to be tied to ED

CAHPS performance by end of 2015


High Performing ED’s Will Lead, Not Follow

= Efficient

Patient Flow

Foundational

Must Haves® + High Performing

Emergency

Department


Emergency Department Must Haves®

Phase I:

Foundational Must Haves:

Phase II:

Advanced Tactics:

Rounding for Outcomes

Leader Rounding on

Staff and Providers

Leader Rounding on

Patients

Key Words – AIDET®

Post Visit Phone Calls

Hourly Rounding

Bedside Shift Report

highmiddlelow®


Is Your ED Ready to Survive the New Era?

Set clear goals and measurable outcomes. What gets measured gets

results.

Face your flow issues. Improved efficiency:

Reduces wait times

Improves clinical quality outcomes

Increases patient perception of care

Leverage your ED providers and staff

Hardwire the evidence-based tactics- No excuses!

Round regularly and provide timely feedback

Recognize those exceeding expectations and coach those who need

improvement

Deal with low performers- you can’t afford not too!


Always Bring it Back to Values

Every patient deserves high quality emergency

care every time on every encounter.

ED providers and staff make a difference every day

in the lives of patients and families. It’s never a job,

it’s a calling.

We must be relentlessly committed to saving lives

and restoring health.

Remember, by putting these evidence-based

tactics into place, the life you save may someday

be your own!


No ED Left Behind

Our

Emergency

Departments

are the

FRONT DOOR


www.studergroup.com/institutes

June 19-20, 2013, Chicago, IL

November 6-7, 2013 Dallas, TX

Get It Right in the ED and Set the

Stage for Getting It Right Everywhere

Else

Join Stephanie Baker, RN, MBA, CEN, Dan Smith, MD, FACEP,

& Kirk B. Jensen, MD, MBA, FACEP at our two day ED institute.

Participants will learn evidence-based tools and tactics to

improve their Emergency Department results and the results of

their entire hospitals, including HCAHPS.

Excellence in the Emergency Department: Hardwiring Flow and Patient Experience

Thank You! Stephanie Baker, RN,MBA, CEN

[email protected]

Additional resources available at

www.studergroup.com

mailto:[email protected]

http://www.studergroup.com/

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