Emergency Department Flow Updates Help Patients Get Safe, Efficient Care

Emergency Department Flow Updates Help Patients Get Safe, Efficient Care

Keep Me Safe is the first and foremost of AdventHealth’s Service Standards. This commitment allows us to continually work to ensure the safety of people in our care. We are honored to have this commitment recognized nationally through The Leapfrog Group’s Hospital Safety Grade survey. AdventHealth Hendersonville has earned 16 consecutive “A” grades in these biannual surveys.

One of the efforts to enhance safety for patients involved our Emergency Department.

In the fall of 2022, the clinical team at AdventHealth Hendersonville observed a troubling trend. Too many patients that were visiting the Emergency Department were leaving before they could be evaluated by a provider. This observation, termed “Left Without Being Seen (LWBS)” is a known quality and safety concern for Emergency Departments across the country. In response to this observation, AdventHealth Hendersonville organized a task force dedicated to improvement in this area.

The higher rate of LWBS wasn’t entirely surprising. At that time, AdventHealth Hendersonville was doing major remodeling to add eight additional examination rooms in the Emergency Department. For an extended period of time during that construction, the waiting room shifted to a temporary space, which was small and seemed cramped during busy times of the day.

At the end of the construction, AdventHealth restored the Emergency Department waiting room to a comfortable and roomy space. This provided noticeable improvement in patients staying to be treated. However, the ED team was still observing times of the day when patients were experiencing longer waits and opting to leave before being seen. AdventHealth saw there was still room for improvement.

The task force asked patients for feedback to help AdventHealth understand their reasons for leaving and not waiting to be seen. One patient offered some useful insight stating, “The waiting room was very crowded. I didn’t want to wait behind that many people.” The team realized that a crowded waiting room gave the perception of a long wait.

The task force then began to study the patterns of patient visits to the Emergency Department. The Emergency Department nursing and physician leadership adjusted their staffing to match the highest volume times.

“With input from our clinical team, we structured our shifts to add coverage for the busiest times of day and evening, and added nursing shifts to support peak times,” shares Josh Darling, MSN, RN, Director of the Emergency Department at AdventHealth Hendersonville. “Our charge nurses were given the autonomy to flex staffing to match our census, which helped us manage the flow of patients.”

AdventHealth continued to work on improving flow and reducing crowding. They used clinical team members and space to move patients through Emergency Department visits efficiently and as quickly as possible, while still taking care to deliver a compassionate, high-quality experience. These efforts helped the team achieve a 2.8% reduction in LWBS. As of May 2024, the LWBS rate was 0.7%, well within the goal of less than 1% LWBS for the Emergency Department.

The work of the task force and the ED team has significantly improved the waiting experience for all patients who visit the emergency department at AdventHealth Hendersonville. When waiting cannot be avoided, the team clearly communicates expectations to patients and families, and continues to extend uncommon compassion to every person coming to AdventHealth Hendersonville for care.

Like many other Emergency Departments, AdventHealth sees some patients coming to the Emergency Department for minor illnesses – coughs and colds – which could be more efficiently cared for with their primary care provider or by visiting AdventHealth Centra Care. Patients who visit the Emergency Department at AdventHealth Hendersonville with non-emergent illnesses will use a fast-track system that helps move them through their visit in the Emergency Department quickly. This, in turn, also helps reduce the LWBS rates.

At AdventHealth Hendersonville, our Care Management team connects with patients and navigates them to primary care providers if they don’t have one. The hope is to prevent the need for a future Emergency Department visit. When cost is a barrier, particularly for patients who do not have health insurance, AdventHealth Care Managers are connecting patients with community agencies that offer free or low-cost care.

“It is critically important that we are part of the solution that helps patients seek and establish primary care at a price they can afford,” shares Gretchen Nicholson, MBA, MT, CPHRM, CPHQ, Director of the Office of Collaborative Improvement and Medical Staff Services at AdventHealth Hendersonville. “Affordable primary care is available in this community. We want to be part of navigating patients to the right care setting for what ails them.”