Cambridge Health Alliance - “Improving the Patient Experience in the Emergency Department”

When Dr. Assaad Sayah came to Cambridge Health Alliance in 2006, he set out to cure the hospital’s Achilles Heel. With nearly 100,000 visits and only 21 treatment spaces, the hospital’s three emergency departments were stretched thin. Improving the ED was key to staying competitive and profitable, as two-thirds of the hospital’s admissions originate in the ED. Dr. Sayah and the leadership team launched a full-scale redesign of the emergency department to reduce overcrowding and improve patient flow—the largest process improvement program in CHA’s history.

The new plan, which centered on improving the patient experience, eliminated lengthy processes such as registration and triage. Instead, patients answer three short questions with the help of a “patient partner,” and are taken to a rapid assessment area to see a nurse or physician’s assistant—a process that takes less than 5 minutes. Roughly 40 percent of patients are registered, treated and discharged directly from this location. Urgent patients are immediately taken to the acute care area and seen by a provider within 10 minutes. Registration is done at the bedside after the patient is stabilized. “We reshuffled priorities so that ours align with the patients’,” said Sayah.

Improving communication was a linchpin of the redesign effort. When a patient is registered from the ED, an automatic page and email are sent to their primary care physician. Upon discharge, the patient’s doctor receives a full report on labs, interventions, discharge instructions and prescriptions. The hospital also standardized procedures and computer systems across its three EDs.

“Nothing is the same as three years ago,” said Sayah. Efficiency, quality and patient satisfaction have improved. In the last 3 years, Cambridge Health Alliance has grown ED volume by 25 percent. Ninety-four percent of patients are seen within 30 minutes of arrival, versus more than 90 minutes or more before the redesign, and the average length of stay has decreased by 13 percent to 2.5 hours. The percentage of patients who leave without being seen has fallen from 4.2 to a record 0.83 percent.

With more than 10 years of ED leadership experience, Sayah trains hospitals across the country on ways to improve throughput. “It is doable. The secret is changing the culture of the ED and having hospital leadership onboard,” he noted.