Maine Hospital Speeds Patients’ Admitting Time from the Emergency Department After Using AHRQ Tools

April 2020

LincolnHealth, a 25-bed critical access hospital in Damariscotta, Maine, improved the timeliness of admitting patients from the emergency department into a hospital unit after implementing team training tools based on results from the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey.

The hospital reduced the time it takes to admit an ED patient by 10 minutes after changes were implemented based on information gained from the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey. Safety culture survey responses in all categories also improved.

"The AHRQ hospital survey was beneficial to get baseline information to set priorities. Our goal was to improve handoffs and transitions from the ED to inpatient units, which affects patient safety and patient satisfaction," said Bridget Miller, Regional Director of Operational Development and Strategic Alignment.

"When people come to the ED—even if they get great service—if it takes too long to get an inpatient bed, they’ll primarily remember that they had to wait," Miller said.

The hospital administered the AHRQ hospital survey in 2017 and 2018 to assess patient safety culture improvement after implementing an initiative to decrease time from the ED to inpatient care. LincolnHealth also aimed to increase scores on two survey composite measures: "Handoffs and Transitions” and “Teamwork Across Units."

After the initial SOPS results, Miller and her colleague, Michele Sawyer, RN, both TeamSTEPPS® master trainers, focused on teamwork using TeamSTEPPS principles. TeamSTEPPS is an evidence-based system that helps improve communication and teamwork skills among healthcare professionals, boosting patient safety and quality of care. It was developed jointly by AHRQ and the Department of Defense.

Miller and Sawyer built a team consisting of frontline staff from all departments involved in admissions to the hospital from the ED, which included staff from ED, inpatient units, and shift supervisors, as well as patient registration, administration, and environmental services staff. This team met weekly to understand and map the workflow from the ED to inpatient care to understand the process and barriers, analyzing the workflow for opportunities to streamline the process. They translated the workflow into an easy checklist and trained staff on a new process to reduce that time and increase teamwork across the units.

After implementation of the new method, the team met for another 9 months to evaluate and tweak the new process. Miller and Sawyer’s team gave constant feedback to all departments involved and received buy-in from staff.

The hospital has achieved its goal of reducing time from ED to inpatient bed, almost always keeping the time below 30 minutes. In 2016, the average time was 38 minutes; by 2019, that time was down to 28 minutes. In addition, the hospital’s survey scores improved in the domain of "Handoffs and Transitions" by 8 percent.

Miller found it vital that her team focused on process issues to avoid personal and departmental defensiveness. This proved both helpful and successful in getting staff members to come together as a team. The teams came to understand and appreciate the roles of different parts of the hospital staff.

The result has been better patient care and improved intra-hospital relations. "Several good relationships were established across department lines," Miller said. Survey results on "Teamwork Across Units" validated this: the hospital’s scores rose 7 percent.

For example, the teams came up with the idea of placing a stop sign magnet with an estimated “room-ready time” on the door of empty patient rooms that were in the process of being cleaned. These signs were a visual management tool that showed the nursing staff the time when the room would be ready for another patient. This simple suggestion improved the environmental staff’s ability to work quickly without the interruption of multiple questions and calls asking when the room would be ready, reducing tension and improving morale.

LincolnHealth’s success was highlighted in a webinar in November 2019 hosted by the Beryl Institute, an organization that focuses on patient experience of care. The 1-hour event featured three hospital employees—an ED nurse, a shift supervisor, and an inpatient nurse—who presented the story to nearly 100 webinar attendees.