CRMC ED Operational Redesign
Background
The Emergency Department at Charles Regional Medical Center, a community-based hospital in La Plata, Maryland, was seeing 54,000 patients annually. Despite changes implemented by the Emergency Department leadership team, the emergency department remained crowded, with 25 or more patients in the waiting room by the afternoon. Patient experience scores took a precipitous drop.
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Analysis
The emergency department had three separate treatment areas, a Main ED staffed with physicians and two lower acuity areas staffed with PAs and NPs. A dedicated bed model was used, where every patient was placed in a treatment bed and remained there for their entire stay. The Main ED was often overcapacity, while the other two areas would be underutilized, with patients waiting hours to be seen.
Operational Redesign
Analysis of patient arrivals, acuity, and workload revealed that there were simply insufficient beds to run a dedicated bed model for all patients. Construction of new beds was not only prohibitively expensive, but there was no room for expansion. Thus, a vertical patient model was implemented for lower acuity patients.
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Neither the nurses’ nor medical providers’ schedules matched up well to patient demand, nor with each other. Physicians or APPs would find themselves without the requisite nursing support during certain portions of their shifts. Nurse and physician staffing were right-sized and matched to patient demand.
Nurse Staffing vs. Demand: Before
Nurse Staffing vs. Demand: After
While separate treatment areas may be necessary as emergency departments become larger, increasing segmentation creates greater challenges with patient load-leveling, to prevent one area from being overwhelmed while another is under-utilized. Consequently, RME and CDA were combined into one unit for low and moderate acuity patients, reserving the Main ED for high acuity, complex patients.
Results are listed in the table below:
Patients were pleasantly surprised to walk into the emergency department and be evaluated by a provider promptly. Nurses and physicians were no longer confronted with angry patients who had been waiting for hours. Patient experienced score reflected this change.
