Improving Emergency Services at HCA

With more than 100 million ER visits in the United States each year, managing emergency rooms effectively is a challenge. Patients expect to be treated quickly – whether they’re having a heart attack or simply need treatment for a small cut.  

Concerned about finding ways to decrease patient wait times, HCA pulled together a team of 85 medical, quality and risk management experts in 2002 to analyze operations that affect patient care in the emergency room.

The team developed several strategies for optimizing patient flow, enhancing the effectiveness and efficiency of patient care, improving patient satisfaction and minimizing the level of confusion that impacts patient care decisions.

Two such strategies included improving measurement and monitoring and how patients are prioritized for treatment in the emergency room.

Improving measurement and monitoring

In 2004, HCA introduced five measures for capturing and evaluating wait times in the HCA Emergency Departments. These five measures include time of arrival, time placed in bed, time greeted/contacted by a physician, time disposition decision was made and time patient leaves the ER.

This information was captured for each of the 5.3 million ER visits to HCA’s 199 emergency rooms in 2004.  HCA is now in the process of implementing a system-wide program that will combine the measurement data with each patient’s diagnosis, outcome, demographic, payor and billing info.  By analyzing this information, HCA will be able to estimate volume by time of day, determine how much staff is needed and when and determine which areas are in need of technology. 

Improving the triage process

Statistics show 12-15 percent of hospitals nationwide do not have triage nurses who are trained to make an initial assessment of patients and to make a decision on how quickly the patient needs to be treated.  After HCA found this statistic applied for its own facilities, the company put a new emphasis on providing nurses the necessary tools and training to consistently and compassionately triage patients. Through a partnership with Triage First Education Services, triage training is becoming a standard competency for ER nurses in HCA hospitals.