“The flow process works so well now that the current door-to-balloon (intervention) time at Virginia Mason is 42 minutes – cutting more than half the time recommended by the American College of Cardiology and American Heart Association.’’
- Sharon Mann
Flow matters in every area of health care, but perhaps no where is it more important than in the Emergency Department (ED) where it can save lives. Virginia Mason’s new ED is the result of years of work aimed at perfecting flow in pursuit of the perfect patient experience.
“When patients arrive at the ED in an urgent or crisis situation, we want to make them feel as though we’re expecting them and welcoming them, not that they are an inconvenience or that we are busy and they are a nuisance,” says Sharon Mann, RN, MS, NEA-BC, director, Virginia Mason Emergency Services.
The welcoming environment the VM team has created wouldn’t sustain itself long if the underlying processes within the ED were not so focused on the flow of patients.
A key part of the flow is setting up the system so patients with lower acuity problems never have to penetrate deeply into the ED, but are quickly evaluated in a Rapid Medical Evaluation Area. These patients get diagnosed and treated quickly in a separate area, leaving the bulk of the ED free for higher acuity cases. This one change in flow among many has made a significant difference.
A great example of the advanced flow work that makes a huge impact on the patient experience involves heart attack patients brought into the ED. The old protocol was siloed. But a deep dive using tools of the Virginia Mason Production System (VMPS) broke down the silos and integrated the teams with a laser-like focus on what is best for the patient.
This is where the tools of VMPS really pay dividends for patients. The two teams – ED and cath lab – came together and looked at the entire process from the patient’s point of view. The challenge was how do we work together to create the best possible patient experience?
A key part of the answer proved to be the idea of external setup, an important VMPS concept. It used to be that the ED did ED work and the cath lab did cath lab work, and they did not cross borders. But a breakthrough came when the teams agreed the ED team could do most of the setup work for the cath lab in advance. Thus, heart attack patients in the ED receive an EKG, sign consent, are gowned and ready to roll into the cath lab where the interventionist procedure can be done right away. Flow in the ED is now smoother than ever.
“We had a kaizen event that brought the two teams together to leverage what both teams could do for each other,” says Sharon. “So now, the ED does setup for the cath lab – the prep work – so the patient is already prepped when they arrive in the cath lab and they can start the interventional procedure for the patient right away.”
In fact, the flow process with heart attacks starts before patients arrive in the ED.
“Medics call in from the field and let us know they have a patient with chest pains or, in some cases, they have done the EKG in the field and confirmed the heart attack,” says Karen Gifford, RPh, administrative director, Emergency Services. “We immediately prepare a team and a bed. We have an alert that brings techs, nurses and physicians to meet the patient on arrival and begin working right away.”
Thus, the whole team is in place and ready before the patient arrives.
The Virginia Mason goal is to complete an EKG within five minutes of the patient’s arrival and to get the patient to the cath lab within 15 minutes upon arrival to the ED. When they began the focus on this work a few years ago, the American College of Cardiology and American Heart Association (ACC/AHA) urged hospitals to achieve a door-to-balloon (intervention) time of 90 minutes or less.
But the VM team wanted to do much better. Through the years, VM teams had applied VMPS tools and concepts to a variety of areas and eliminated enormous amounts of waste. Thus, they started their work setting a goal of 60 minutes for door-to-balloon time.
“The flow process works so well now that the current door-to-balloon time at Virginia Mason is 42 minutes – cutting more than half the time recommended by the ACC/AHA,” says Sharon. “This is a great boost to patient experience and to the lifesaving quality of care provided in the ED.”
The flow work in the ED has certainly paid off. The ED patient satisfaction rate is pushing 90 percent (according to Press Ganey), a truly impressive number. It is important to note this has been achieved in a new ED unit with fewer beds than the previous unit, a testament to the relentless kaizen work by the team and a clear confirmation of the power of VMPS to reduce waste and improve efficiency and patient-centeredness.
“We really created that relational shift between the two departments that didn’t exist previously,” says Sharon. “Now, we work as one team for the patient.”