The no waiting, ER “waiting room”

image A February 28th article in the Wall Street Journal discusses the plight of emergency room patients at the University of Chicago Medical Center.  According to the article, medical center administration had plans to decrease the number of hospital beds allocated to patients coming through the medical center’s ER.  Opponents of the plan proclaimed that patient safety and ER waiting times would be negatively impacted.  They alluded that the administration’s motivation for cutting the bed supply was to make more room for insured patients that bring higher margins to the hospital.  The WSJ article states that the plan to reduce ER beds at the University Medicalimage Center is now on hold after protests from some of the medical staff.  Also cited in the article are some frightening statistics on how long ER patients are currently waiting at UCMC to be seen by a physician.   A 2007 internal report on the emergency department says that on many afternoons and evenings, the wait-to-be-seen times often exceed 8 hours.  The very sickest patients who require admission to the ICU may wait up to 14 hours!  Of course, as a physician I know that what is happening at UCMC is happening in emergency rooms across America.

The article seems timely in juxtaposition to an announcement made today by another University Medical Center.  The Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, is building a better way to deliver emergency care. Earlier today, the Medical Center showcased its novel, patient-friendly model of emergency care, which will reduce wait times and improve the delivery of emergency services.  The model includes a no-waiting arrival area, where physicians and nurses triage patients to treatment areas according to their severity of illness or injury regardless of whether they arrive by way of ambulance or private vehicle.  What makes the no-waiting plan possible?

image According to Christopher DeFlitch, M.D., chief medical information officer and Emergency Department vice-chair at the Medical Center, “Rather than simply building more of the same or expanding waiting rooms, we used scientific principles to study our processes and build inherent change in the delivery system. This model lets us provide patients the right care, at the right time, in the right location.”

The team at Hershey utilized information technology to optimize their limited resources and change how they did things.  DeFlitch and his team began working with the information technology and industrial engineering staff at Penn State-University Park to find ways to do more with less. Through a process called health care engineering, which applies flow modeling, queuing theory and advanced information technology to health care processes,  the Medical Center has created a unique model that will improve access to, and the quality of, emergency care at lessimage cost.  Information technology for the project was supplied by Orlando Software Group (now part of Bluesprings Software) and made use of commercial, off-the-shelf software including Microsoft Visio.

The Penn State Hershey Emergency Department sees more than 50,000 patients each year in a 24,000-square-foot space designed for less than 30,000 visits. Initial estimates to expand the space by 20,000 square feet came with a price tag of nearly $20 million.  By making processes more efficient, the Medical Center needed to add only 7,000 square feet of space and spent less than $4 million on the expansion.

If you would like to learn more about Penn State Hershey’s use of workflow process engineering in the design of the medical center’s new ER, please read an earlier post on HeatlhBlog, Can Workflow Reengineering Improve Patient Care?  You can also listen to an audio-cast I produced on this topic.  My guests include Dr. Christopher DeFlitch along with Frank Kapper, Vice President and principal partner of the Orlando Software Group and my colleague Ingo Heel , Microsoft Industry Sales Director for LEAN.

See Applying analytics tools to boost organizational efficiency and optimize patient care

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Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

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