BOSTON, MA – Emergency departments at many hospitals have been overwhelmed in the past year, as more patients without health insurance use the ED as a primary care solution.

But as wait times get longer, one ED director says simple fixes such as shuffling around a surgery schedule can help a hospital improve time management in the ED, align its finances and boost patient and physician satisfaction.

“The ED is not the problem,” said Sherron Kurtz, director of surgical services at WellStar Kennestone Hospital in Marietta, Ga. “The elective surgery schedule is the problem.”

Kennestone, a 633-bed tertiary care facility, started a patient flow project about three years ago to reduce wait times and improve patient satisfaction.

The project was initiated due to an overcrowded ER, Kurtz said. Patients were boarded in the wrong wards, including the ER, and surgeries were running long into the night.

At the project’s start, Kennestone had no data to help improve its situation, Kurtz said, and “data is important for achieving credibility.”

Data poor, the hospital turned to Press Ganey, a firm whose work focuses on healthcare performance measurement and improvement.

The South Bend, Ind.-based company offers consulting services for underlying improvements to help prevent scheduling problems in hospitals and their resulting “bottlenecks.”

“The services (we offer) are a collaborative approach,” said Susan Madden, vice president of patient flow analytics at Press Ganey. “Decisions are made in partnership, but Press Ganey oversees and maintains operations.”
Madden said the patient flow implementation process comes in three phases, lasting 6-9 months each.
With the help of the data Press Ganey accumulated, Kennestone worked out a new scheduling system. Some surgeons were skeptical of the process, but the data was convincing.

Since implementing the new patient flow system, Kurtz said cases in the ED have become much more predictable and 94 percent of patients are boarded on the correct floor.

Length of patient stay has also decreased and there is more “truth in scheduling,” Kurtz said. Only 15 operating rooms run until 5 p.m. and eight of these are open until 7 p.m. whereas, prior to implementing a data-driven patient flow system, operating rooms stayed open twice as long.

Perhaps most importantly, patients visiting the Kennestone ED saw a 78 percent reduction in wait time, allowing urgent cases get into the operating room much faster, Kurtz said.

Only one overnight surgery team is required in the OR, she noted, as opposed to the two that were necessary prior to the new system.

According to Madden, when hospitals implement patient flow systems, patient volumes rise, on average, by 10 percent and employee overtime drops by 63 percent.

Processes become more predictable and operating room minutes also decrease by 63 percent in hospitals of various sizes, she said.