Medical City Lewisville February 13, 2014

In recognition of dramatically improving its emergency department turnaround time, Medical City Lewisville has been named the 2012 recipient of the Texas Hospital Association’s Bill Aston Award for Quality in the Non-Research / Non-Teaching Hospital / Health Care System category. The award will be presented Feb. 13 at the THA 2013 Annual Conference and Expo in Austin.

“Medical City Lewisville has demonstrated a long-standing commitment to improve the health of every member of their community by providing timely and efficient operations that result in increases in patient satisfaction. Their leadership in this area shows keen insight for where health care is headed in the future, and we applaud their effort,” said Dan Stultz, M.D., FACP, FACHE, THA president/ chief executive officer.

In 2009, the 18-bed emergency department at Medical City Lewisville was overcrowded, hall beds were needed daily, and inpatient units were consistently full. The average ED turnaround time from door to discharge was more than 200 minutes. Patient satisfaction was low, and staff morale was poor. The hospital’s leadership recognized the need for significant changes.

“We are gratified to receive this prestigious award,” said Ashley McClellan, FACHE, MCL chief executive officer. “This honor reflects the hard work, passion and dedication of every member of our hospital staff to excellent patient care.”

In January 2010, MCL set a lofty goal of improving emergency department turnaround time to 130 minutes or less. Through a hospital-wide, multi-disciplinary team approach, all the organization’s leaders were tasked with helping meet this goal. Within seven months, they met the 130-minute benchmark and have sustained it ever since. MCL has led Medical City Healthcare in meeting or exceeding ED throughput goals for the last 29 months and is currently ranked in the top 10 within HCA nationwide for high-performing emergency departments.

The first step in implementing the initiative was to put together a facility implementation team that included representatives from all areas of the hospital. Every department was required to set goals that would help bring down ED turnaround times, and leaders were evaluated and rewarded based on their performance on these goals.

“The turning point came when the hospital executive team took on the initiative as a hospital-wide goal,” said Carl Menckhoff, M.D., medical director of the MCL Emergency Department. “Some people see ED wait times as an ED problem, but it is really a hospital problem.”

One of the team’s first actions was to measure the amount of time it took to complete each step in the throughput process. That included the time from arrival to being admitted to an ED bed; the time to the doctor’s arrival at bedside; the time spent in diagnosis and treatment; and, if the patient was to be admitted, the time spent waiting for admission to a bed.

Medical City Lewisville initiated broad changes that helped reduce wait times and made more efficient use of staff time. Roving admit nurses were implemented to streamline the admission and discharge of patients. A new “bed czar” position was assigned to manage the admit nurses while also performing bed control for the hospital. Rooms were cleaned and made ready for a new patient within one hour. Physicians began seeing ready-to-discharge patients at the beginning of their rounds, rather than the end, to make beds available earlier in the day. Staffing assignments were adjusted to allow for a dedicated ED lab technician, resulting in a decrease in ordered-to-verified time from 53 minutes in the second quarter of 2010 to 21 minutes in the first quarter of 2011.

One of the biggest and most effective changes was allowing the ED charge nurse to make personal phone calls to the administrator on call – at any time of the day or night – when there was an ED hold of longer than 60 minutes. The administrator was then responsible for finding out why there were no available beds and resolving the situation.

Since implementation, the MCL project has met all benchmarks set by hospital leadership. The time from arrival to being seen by a physician has shortened from 41 minutes in 2009 to 12 minutes in 2012; the benchmark of 20 minutes has been met and maintained for nine consecutive quarters. The percentage of clean rooms hospital-wide has increased from just over 60 percent in 2009 to nearly 90 percent in 2012. The turnaround time from patient discharge to being ready to admit a new patient has shortened from more than 100 minutes in 2009 to less than 40 minutes in 2012.

Patients are responding positively to the changes, as well. Emergency department volume has increased more than 22 percent since the ED throughput project was initiated, and patient satisfaction with the ED has increased from 47 percent in 2010 to 70 percent in 2011.

“Nationally, between 3 and 5 percent of patients visiting emergency departments leave without seeing a physician due to long wait times,” said McClellan. “Since the throughput initiative, the average wait time at MCL’s ED is now less than 1 percent. Reducing wait times makes an emergency department visit less frustrating and helps ensure patients get the care they need.”