Memorial Hospital Pembroke - “Simple, Smart Solutions to Improve ED Throughput”

Reducing wait times and improving patient satisfaction were major goals for Memorial Hospital Pembroke’s emergency department. As part of a large health system in South Florida, the hospital absorbs overflow from other hospitals and had more than 36,000 ED visits in 2009. To improve throughput, ER leadership created a more efficient triage process by utilizing several nurses, instead of one, to cut triage time down to 10-15 minutes. In many cases, patients can be treated and discharged directly from this area. “We didn’t change the physical space; we just used the space in a more efficient way,” said Boaz Rosenblat, Medical Director.

With a goal to get patients seen within 30 minutes of arrival, the hospital implemented an “open bed policy” that ensures patients are taken to any open bed, when available, versus a charge nurse taking groups of patients to the treatment area at intervals of opportunity or convenience for the staff. The hospital’s “advanced nursing interventions” allow ED nurses to enter orders for lab tests or radiology exams, previously approved by the medical staff, for common injuries or illnesses that typically present in the ED. Beginning diagnostic testing—even before the physician examines the patient— expedites results and reduces a patient’s overall length of stay in the ED. Using historical data to maximize staffing to correspond with traditional busy times helped ED staff plan for unpredictable patient volume. “You have no control over the pace of patient arrival, and you can never turn someone away. So you have to be prepared for when things get intense,” said Rosenblat.

The hospital has decreased wait times to less than 30 minutes, and patients with non-traumatic chest pain receive an initial evaluation by a physician within 10 minutes of entry in the ED. The length-of-stay for patients who are treated and released was 180 minutes before the interventions; it now averages around 157 minutes. Only 1.65 percent of patients leave without being seen, compared to roughly 2.5 percent nationally.

Memorial also excels in admittance times, admitting patients within 30-55 minutes of the primary care physician’s orders. Patients who need an ICU bed are admitted within 37 minutes—within the top 10th percentile in the NAPH 2009 ED survey. Eighty percent of hospital admissions originate in the hospital’s ED.