Wednesday, February 3, 2010

Respect My Time - Get me out of this hospital


Can you imagine going to Chipotle and having a dining experience for almost 2 hours? For that matter, would you expect to leave a 5-star restaurant within 30 minutes? Every time I visit a restaurant, their focus seems to be on valuing my time and demonstrating value for the food, service and overall experience. By the way, it drives hospital people crazy to compare a hospital experience with a restaurant experience. Interestingly enough though, consumers do look at the experiences in the same way in that they expect us to value their time and demonstrate value for the care (instead of food - though we do happen to serve great food at St. Joseph Medical Center), services and overall experience.

For the past year and a half, SJMC has truly excelled around our Emergency Department diversion (not closing the ED to ambulances) which was a daily practice of the hospital prior to that timeframe. I know that I have bragged about this in prior blog entries. We typically average less than 5 hours with a majority of months at zero. Unfortunately, we saw a spike in January with almost 30 hours of diversion (the majority of this in the first half of the month). This not only hurts our efforts to serve our community, it also increases the length of stay for our patients and reduces our hospital and Emergency Department census.

Note: The Institute for Healthcare Improvement (IHI) indicates that Hospital flow can be measured at several levels, and each level provides a portion of the total measurement picture (see:

Patient and Community
Hospital Throughput
Hospital Activity
Hospital Performance

Fortunately, our nursing leaders took matters into their own hands and changed our Bed Meeting from mid-day to 9:00 a.m. and 3 p.m. A Bed Meeting helps focus on getting our patients most effectively through their hospital stay with a focus on their safety and respect for their time (not many patients want to stay longer in a hospital unless is critical to their health). I am pleased to see that our ED diversions have dropped back down over the past couple of weeks. We will continue to watch the success of the enhanced Bed Meeting and I expect we will see the following improvements with respect to patients' care and time:

- Reduced length of stay for patients who are appropriate for discharge;
- An increase in the the percentage of patients discharged by 11:00 a.m. and
- Reduced length of stay in the Emergency Department (allowing us to get those needing admission to the inpatient floors in a more timely manner and those ready for discharge to go home in a more timely manner).

I would like to thank our nursing leadership team for taking charge of this issue. While it is painful in many ways to change a system that has been in place for many years, it is very rewarding to see that this change leads to better outcomes and experience for those we serve.

I look forward to hearing from you.

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