When Kentucky-based Hardin Memorial Health doubled the size of its emergency department to better serve its growing population, the hospital also added more care team members and implemented a new communication system.
Change management under these circumstances would be challenging in any area of a hospital, but emergency medicine is one of the most stressful types of care. To facilitate the transition, HMH took a multidisciplinary team approach, empowering staff members who care for patients in the ED every day to design the layout of the new space and select its special features.
While this was happening, a new hands-free communication system was implemented and adopted, which translated to better communication between providers, as well as improved efficiency and patient satisfaction scores.
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Deanna Parker, assistant vice president of emergency services at HMH, said in a HIMSS20 digital presentation that growing ED volumes necessitated both the newly expanded space and a better provider communications platform. HMH regularly vacillates between being the busiest and second-busiest ED in Kentucky, and over the past seven years has seen 25% growth in emergency room volume. More than 73,000 patients utilized the ED last year, and more are expected this year.
"Growing volumes of patients in that small space made it extremely difficult," Parker said.
The need for more space was obvious. The existing ED was built for a capacity of roughly 40,000 patients, a little more than half of its projected volume. But concurrent with this problem was a lack of effective and efficient communication between the ED's physicians and nurses, and it quickly became apparent that more space would only solve one of the hospital's challenges.
It also needed to find and implement communications technology that would allow for enhanced satisfaction of both patients and the healthcare workers who cared for them.
"There was somewhat of a feeling of 'us vs. them' when it came to the relationship between the physicians and the nursing staff," said Parker. "At the end of the day that's not what's best for patient care. If you do a root-cause analysis on adverse events that occur, communication is deeply interwoven into those."
In that context, the expansion project was the easy part: The ED increased in size from 16,000 to 33,000 square feet, featuring a more open design replete with glass.
Implementing the new communications technology was in some ways a more complex task. Staff had complained about their previous communications tech not allowing them to review information during patient care, or to even hear their text-message notifications. Before these grievances could even be addressed, the new shared governance structure that was established at HMH had to perform site visits to pinpoint viable communications platforms that were being used at other hospitals.
"We wanted to see with our own eyes how it was impacting their workflow," said Parker. "If I was asking the organization to invest in any kind of software, I wanted to make sure we understood what it was for and how we would use it."
HMH knew it needed something that was easy to use, hands-free and allowed for communication during patient care. And it wanted the care staff to feel a sense of ownership. The hospital settled on a vendor, and worked with both it and the clinical and IT staff on creating new workflows for every person in the ED, including support staff.
"We are so dependent on, for instance, radiology being able to get a reading on a CAT scan and getting that info to us, so a plan of care can be established, so we can make next steps for our patients," said Parker. The goal was to use the new hands-free communication technology to eliminate bottlenecks.
It was a large undertaking from a staff-education standpoint. HMH utilized a multimodal approach, incorporating both computer-based learning and classroom education, as well as other methods.
One of the big benefits to the new tech platform was the ability to set up "broadcast groups" within the app, which allowed care teams to send and receive information to and from only the relevant parties, aiding in the department's efficiency, as well as reducing alarm fatigue. If a patient came in with a stroke, a one-touch alert would let everyone know that it was time to administer a CAT scan. Testing and lifesaving medications were administered more quickly.
The improvements to patient care – and staff morale – has manifested in a number of different ways. A few short years ago, lab turnaround times were up to 82 minutes; it's less than half that now. Door-to-CT times are now under 25 minutes. Antibiotic timing averaged 141 minutes at one point; that average is now 53 minutes. Door-to-room times in the ED once averaged 49 minutes; now the average is 21. The left-without-being-seen rate has been slashed by more than half, dipping from 5.3% to 2.1% as of November 2019.
Patients are happier and staff are happier, and for Parker that has made the effort worth it.
"If you don't have happy staff, you don't have happy patients," she said.
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