Hospitals looking to improve their emergency department volume, patient satisfaction and community perception, typically – and understandably – attempt multiple solutions. And while a myriad of trial and error can eventually lead to success, ECI Healthcare Partners’ experience reveals that hospitals can quickly and significantly improve all three if they focus first on one factor: efficiency.

Traverse City, Mich.-based ECI Healthcare Partners has been helping transform EDs from struggling to strong since 1972. Founded by two of the first emergency medicine physicians in the country, Dr. James M. Johnson and Dr. Robert M. Williams, ECI Healthcare Partners today provides staffing, management and revenue cycle management services to 145 emergency departments, hospitalist programs and urgent care centers in 28 states.  

“If there is a secret to helping our partner hospitals find success, I’d say it’s that we tailor solutions to each facility’s particular needs and challenges,” says Dr. Michael Frye, a board-certified emergency medicine physician and one of ECI Healthcare Partners’ regional medical directors. “But no matter what the program, one of the first things we zero in on is efficiency, because improving it has an immediate, positive impact on the quality of care being delivered, the patient experience, and even the provider experience. Essentially, better processes make room for better care and a better practice environment.”  

On the Front End

Where to start? ECI Healthcare Partners always evaluates three key segments in the patient’s care experience, starting with what Frye refers to as the “front end.” Essentially, he says, “[The front end] involves the patient arriving to the emergency department, going through registration and the triage process.”

Triage, he explains, consists of the standard services that patients receive when they come to emergency departments. “You’re making a determination of how sick they are, what resources they’re going to need and how you would put them in a waiting order to be seen,” Frye says. 

Often ECI Healthcare Partners identifies opportunity for a “pull-to-full” process, in which patients register, go through the triage and are immediately placed in beds in the ED, instead of going back to the waiting room. “You cut a significant amount of time,” he says, noting that this system often saves patients an average of roughly 20 minutes during their visit.

It also makes work easier for nurses, Frye says. “It’s in everybody’s best interest to get patients in more quickly,” he says. “What we find is that once nurses embrace the pull-to-full process, they like it much better, and the patients are happier as well.”

Another way ECI Healthcare Partners expedites the front end of the experience is by implementing a care provider, typically an NP or PA, in triage. “What this does is significantly shorten the amount of time from arrival to seeing a provider,” Frye says.

“One of the key metrics that hospitals follow is called ‘door-to-provider time,’” he continues. “By putting a provider out front in the triage, where they do an initial assessment and screening, it helps to get lab tests ordered up front and gets all processes moving more quickly.”

It also enables lower acuity patients to be discharged from triage, which opens up beds for other patients to be seen. “This is another process that requires some intensive change management, as you’re moving a lot of what’s done in the back up to the front,” Frye says.

“But we have very good feedback on it from a provider and a nursing satisfaction standpoint,” he reports. “The patients also love it, as they are seeing someone right as they walk in, get registered and sit down in a chair.” 

Another bonus? The less time patients spend waiting to see a provider, the less likely they are to walk out without being treated (LWOT), a key metric that means sick patients either aren’t receiving the care they need or going somewhere else to get it – a dangerous prospect for any hospital concerned about its community and bottom line.

Improving the Metrics

The second segment where ECI Healthcare Partners looks to accelerate care is in the “in-department” stage, Frye says. If, during the triage, nurses feel that all a patient needs is one visit by a physician and then can be immediately discharged, that patient is sent to an internal waiting room with a nearby exam room.

A provider calls on the patient from the internal waiting room, examines them in the exam room, and the patient is then sent back to the internal waiting room to be discharged. “What this does is remove this low acuity patient population from the normal departmental flow,” he explains. “When the department is busy, this lower acuity population of patients can routinely wait two hours or more to be seen and then occupy bed space needed for the sicker, more time-consuming patients. Removing them from the normal departmental flow gets them seen much more quickly and at the same time does not hinder the flow of sicker patients. I like to call this creating virtual bed space. It effectively increases the size and capacity of the department and markedly increases patient satisfaction.”

ECI Healthcare Partners has had much success with this model, he reports. “We’re able to increase productivity metrics by 15 to 20 percent per provider,” he says. “They do that by working smarter instead of working harder. And patients in this situation are more willing to fill out a satisfaction survey. From satisfaction to time, the metrics are improved more efficiently.”

Credit for the company’s mastery in improving metrics is not due to proven processes alone. The vital piece of the puzzle is the medical director: his or her ability to monitor and measure those metrics, implement and guide the processes, and lead the emergency department clinical team and staff.

ECI Healthcare Partners places immense value on the leadership and management skills of its medical directors. The company not only puts each of its medical directors through fairly intense leadership training but also gives each a hands-on mentor: a regional medical director who is also a board-certified EM physician with extensive management experience. Each regional director works closely with medical directors to teach them how to most effectively manage emergency departments. “This is clearly something that’s rare in the industry,” Frye states.

By putting so many resources and support into ED leadership, ECI Healthcare Partners is able to create better practice environments, which allows providers to feel more satisfaction in their work –  a result that consistently reduces provider turnover, increases ED stability and mitigates provider burnout. “You add years on physicians’ careers by teaching them these concepts and making them frustrated less often,” he says.

Making Impressions

The third segment, known as “the back-end,” can be very difficult to improve, Frye admits. 

“[It involves] getting emergency patients who need to be admitted into the hospital upstairs more quickly,” he explains, noting that ECI Healthcare Partners turns to the facility’s entire staff for input.

Not only does ECI Healthcare Partners concentrate on moving patients, but also works on how physicians order tests for patients. “From a physician side, it’s one of the most time-consuming things they can do,” he says.

“It’s important to make sure that test is truly needed for that patient,” Frye says. “This is a concept that takes some time when working with providers, [so we] get them comfortable with different ways to effectively manage test orders.

“This helps with your utilization numbers and what tests are being used,” he says, noting that doctors also have to make sure patients understand why the test is being ordered. “To order a test probably adds an hour to an hour-and-a-half to their stay.”

It also can impact patient satisfaction, Frye explains. 

“That extra minute to explain why you’re ordering a test, or not ordering a test, gets them the appropriate treatment that they need,” he says.

Patients who experience the effects of these improvements are more likely to fill out positive satisfaction surveys. “They’re also going to be good word of mouth for their neighbors,” he adds. “One of the keys to providing good care is listening to the patient and actually involving them in their own care.”

That positive impression also makes it easier for the rest of the hospital’s team to do their jobs, including the ED and ancillary staff and the X-ray department, Frye says. “If you’re more appropriately ordering these tests, you free the rest of the staff to be doing what is most needed,” he says.

Great Rewards

ECI Healthcare Partners’ work is not easy, as it involves commitment from the entire team, Frye admits. “Changing [habits] requires some fairly intensive change management activities to work through and improve the outflow,” Frye says.

But the results are worth it. At one hospital that had an average volume of 38,000 patients a year, ECI Healthcare Partners recently implemented its front-end processes and saw great rewards in short order. 

“We decreased our door-to-provider time from around 50 minutes to right about 28 minutes,” Frye says, noting that soon after, the hospital earned better word of mouth that prompted a 20 percent increase in volume. 

“Not only were we getting people seen more quickly, we were seeing more of them.” 

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