Newswise — Montefiore Medical Center's three emergency departments (ED) are the busiest on the entire East Coast, according to a May 2, 2005 publication of the respected health care industry magazine, Modern Healthcare. To improve care to this huge volume of patients, who account for more than 180,000 visits annually, the ED at Montefiore's Weiler Division began an experiment a few years ago -- an official program to instill friendliness and efficiency into its operations.
The results have been remarkable: patient satisfaction has climbed dramatically, community visits to the ED have jumped 15 percent and hospital admissions from the ED have soared 30 percent from 2001 to 2004. Meanwhile, hospital ED visits in the Greater New York region have remained relatively flat, according to data from the Greater New York Hospital Association.
"Keeping patients happy and comfortable by having them treated quickly and respectfully 24/7 by board certified emergency department physicians is what drives visits and admissions," said Peter Semczuk, vice president of Clinical Services at Montefiore. "In a competitive environment like New York City's, the experiment has transformed our ED from a place of seeming chaos into a model for emergency care and a new source of hospital admissions."
Drastically Reduced ED Waiting TimesTo make sure patients do not wait too long, one of the most common complaints in EDs, Montefiore has adopted a five track system of care which operates around the clock. Patients who have burns or mild cases of asthma, designated as needing level 4 and 5 care, are now diverted to a "fast track" program, located in a separate, new wing of the ED, where they receive outpatient care immediately.
"Several years ago, these fast track patients were penalized and got angry as they waited for hours in the ED because they did not have life threatening emergencies," said Alice Corbett, administrative nurse manager at the Montefiore ED. "Now we see them right away and they no longer leave in frustration." Here's how things have changed. In 2001, 5.2 % of registered ED patients "eloped," or left because they were waiting too long. In 2004, under the fast track system, only 1.5% of ED patients eloped.
In addition, overall fast track registrations have doubled in the past two years, from 800 visits in January of 2003 to 1,600 fast track visits in January, 2005. The registrations spiked during the weekends or late at night when other outpatient clinics and physician offices were closed.
Three Tracks for Most Serious Emergencies Improve OutcomesBy adopting effective protocols for the most serious and prevalent emergencies, such as acute heart problems and acute infectious diseases, and by having board certified physicians on call 24/7, Montefiore has also been able to minimize mortalities for these higher tracks of care in the past few years, according the Semczuk.
These tracks include: level 1, for patients who need life saving resuscitation, and who are admitted immediately to the ED; level 2, for patients who encompass a wide range of extreme illnesses, who are also seen immediately; and level 3, for patients who require urgent care, and who are admitted and seen by a physician in 2-6 hours.
Tea Times and a NOD Result in Improved Patient SatisfactionTo make patients more comfortable in its ED, Montefiore has also adopted a range of new initiatives to provide more personal TLC. Doctors, for example, are encouraged to prop up patients with pillows; nurses roll out a "tea time" beverage cart for waiting patients and families and bring them hot meals at lunch and diner; and, all staff greet each patient with a friendly NOD, "name, occupation and duty." As a result, visits keep climbing and patient satisfaction is at an all time high.
"We now measure success by patient satisfaction and we use outside agency surveys to do that," said Semczuk. "Montefiore's ED patient satisfaction score, as measured against its peer hospitals in New York City by a survey company called Press Ganey, went from a low 25th percentile in 2001 to a much higher 70th percentile in 2004."
Friendly (or Your Fired!), Board-Certified ED Doctors"Every physician in the ED is now board certified, which sets us apart from most institutions," said Joseph Braverman, MD, chief of the ED at the Weiler Division. "But we also have a team philosophy that creates a wonderful work environment. Our motto is: 'if you are not nice to patients and to others, you don't work here anymore.' That creates a positive attitude among staff and patients alike."
"Along with quick registration and steering patients to one of our five tracks of care to receive prompt treatment, we have also instituted a patient call-back program just to see how each patient is doing at home after he or she leaves the ED," said Corbett.
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