Improving the Patient Experience in Einstein Philadelphia Emergency Department
The emergency department at Einstein Medical Center Philadelphia is one of the busiest in the city, treating about 95,000 patients a year. The ED accounts for roughly 70 percent of admissions to Einstein Philadelphia annually. Not surprisingly, it is a hive of activity, key to the hospital’s mission, and regarded as one of the best at what it does—treating patients often under the most difficult of circumstances, from trauma to diabetic emergencies to heart attacks, and more.
That said, everything can be improved, and the Einstein Philadelphia ED is undergoing significant physical renovations and streamlining operations, all focused on improving patient flow—and the overall experience of those patients. The physical renovations are scheduled for completion by the end of 2018.
“Our overarching goal is to have patients seen as soon as possible by a provider, complete their care efficiently and keep them moving through the system,” says Elizabeth M. Datner, MD, FACEP, chair of the Department of Emergency Medicine at Einstein Healthcare Network. “One of the things that happens in emergency departments is that when every patient stays in a treatment room while they are waiting for things to happen, all of those rooms get filled up and you can’t accommodate another patient—and that’s when new patients get backed up and wait to be seen.”
Dr. Datner offers what might seem like an unlikely comparison to Disney World: “At Disney, you’re moving through the line even if you aren’t yet on the ride.” In a similar way, she says, the Einstein Philadelphia ED can move patients through the system more efficiently. “Not all patients have to stay in a treatment room while they’re waiting to get an X-ray or a test result. They should only be in the room for the things they absolutely need to be in the room for, like exams, private conversations or invasive treatments, and that allows us to accommodate more patients who need our services.”
The newly redesigned process includes an up-front location for the check-in nurse—called a pivot nurse—who can see patients when they first arrive in the emergency department, says Steve Chapman, MBA, MS, RN, senior director, Emergency Services. There’s also a rapid assessment doctor, who can begin patient care as soon as possible—even if the patients are still in the waiting room.
“If you come in with a possibly broken wrist and you’re sitting in the waiting room, the doctor can see you in our Rapid Assessment area and order an X-ray. You can get your X-ray done and go to a fast track area or a ‘results pending’ room to get your results. You don’t have to spend all that time waiting for an exam room to be free. You can get your care initiated right away and move through the process. So, we’re bringing the provider to the patients, wherever they may be, as early as possible.”
The results pending room offers seven recliners and televisions.
Additionally, there’s an operations resource center that has been established in the hospital, an effort to bring together all of the resources that are needed to smooth patient movement in the hospital into one space, further facilitating and improving the flow of patients through the emergency department.
Dr. Datner explains. “Who is looking at all the beds that are available? How quickly can the rooms be cleaned after the patients are discharged? How do we coordinate transporting patients into and out of those rooms? Having all those resources in one place and having them all work together in a more efficient fashion allows that process to happen more quickly. In turn, that allows patients admitted from the ED to move upstairs more quickly and opens space for new ED patients.”
One further enhancement: an observation unit, which Dr. Datner explains has been in existence for some time, but now falls under the umbrella of the emergency department. Some patients are too sick to be treated and released in the emergency department, but are not necessarily sick enough to be admitted to the hospital. They just need a period of observation and minor treatment until they’re well enough to be sent home or it becomes clear that they need to be in the hospital for a longer period.
That’s where the observation unit comes into the picture.
“These patients need a longer period of care than what can be provided during the ED visit to determine if they can go home or need more time,” says Dr. Datner. For example, an asthmatic patient who just needs a little bit more than a few-hour assessment and treatment in the emergency department might need 18 hours of frequent nebulizer treatments. Or, they have vomiting and diarrhea, are dehydrated and continue to vomit. If we can’t get that under control in the ED, we might put them in the observation unit for a period of time where we can continue to provide fluids, get their symptoms under control and then send them home. They don’t really need a full hospital admission.”
Most of these changes are expected to benefit staff as well, although improving the experience for patients remains the paramount priority. Treatment spaces will be neater and brighter, says Chapman, but beyond that, when patients are able to be attended to early and quickly, that feels much better to staff, too.
“We talk a lot about burnout in our field because much of what we deal with is emotionally exhausting,” adds Dr. Datner. “Patients can be angry when they have to wait long periods of time. So, to be able to treat patients immediately and initiate their care much sooner is satisfying for providers because we know we are meeting the needs and expectations of our patients.”
Photos by Wes Hilton