Leader and Hourly Rounding Drive Gains
from the 6th to 99th Percentile
with ED Medical Director Dr. Paul Andrulonis and ED director Donna Sparks at Baptist Miami Hospital, Miami, FL
Back in 2006, our patient satisfaction was chronically in the single digits and our Left Without Being Seen rate was in the double digits," explains Donna Sparks, Director of the Emergency Department at Baptist Miami Hospital in Miami, FL (80,000 annual adult ED visits). Since then, the ED team has created a patientcentric environment that has increased patient satisfaction from the sixth to the 99th percentile nationwide.
Other key outcomes: Since 2006, the number of patients who leave against medical advice has dropped three percent. The ED also reduced Left Without Being Seen patients from 7.5 to 3.06 percent—a $1.6 million positive financial impact in just the last year alone.1
The Tools that Changed the Culture
Sparks credits many of the results to the ED's ability to hardwire leader rounding on patients and hourly rounding on patients by staff. "We rounded on patients in the presence of staff. They could hear us ask patients if staff were rounding on them," explains Sparks. "That validated the importance of the behaviors and drove a culture change. We were relentlessly diligent even when we didn't see our numbers come up. The pay-off came over time."
Emergency department patient flow is like a rope: It works great when you pull, but pushing doesn't get you far. To improve flow, coordinated teamwork should "pull" patients through by anticipating where patients come from and go next, rather than attempting to "push" them through by looking for available beds or waiting for the admitting physician to see the patient and write orders.
While Sparks rolled out hourly rounding to ED nurses, Dr. Paul Andrulonis, Baptist Miami's ED Medical Director, focused on educating the medical staff. "We had lots of challenges," Dr. Andrulonis explains. "We moved from a mid-level physician model to an all physician model, for one thing. We also faced lots of initial push-back from both physicians and nurses."
What helped the most? "Tying these practices to evidence in the literature (e.g. rounding on patients reduces falls and call lights)," he adds. "We also showed physicians what was in it for them…how it would benefit their practice by reducing malpractice claims and improve clinical decision-making by gaining more information at the bedside."
"I remember our Aha! moment," adds Sparks. "We had a pizza party when we finally hit the double digits in patient satisfaction. Staff saw that they could make a big difference for patients…even before we expanded our ED and we had lots of infrastructure challenges. Even patients who were cramped in the hallways appreciated their efforts."
Baptist Miami raised patient satisfaction from the 6th to 99th percentile over four years while reducing Left Without Being Seen patients from 7.5 to 3.06 percent. Since implementing hourly rounding in 2007, the ED has realized a return on investment of $1,558,400 by retaining an additional 3,200 patients.
1 $1,558,400 financial impact is based on average net revenue of $487 per LWOBS patients retained. Reducing LWOBS 4% in FY07 to 09 on ED adult visits of 80,000 yields an additional 3,200 patients.
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