Devices & Technology

The 20-minute ED Promise

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By Suzi Birz, principal, HiQ Analytics

What does it take for a hospital to compete in today’s market? What can improve the patient experience in the emergency room? This month’s Technology Report takes a look at how one hospital achieves a 20-minutes-or-less standard for patients to be seen by physician in the emergency department.


“Genesis is our continual journey to care transformation and creating better ways of delivering health care every day,” said Kevin DiCola, spokesperson for Trinity Health, in Novi, Michigan. An integral element of Trinity Health’s process improvement commitment, Genesis is a system-wide initiative uniting state-of-the-art information systems with evidence-based knowledge to create world-class patient safety, clinical quality and financial performance.

As systems get implemented at St. Joseph Mercy Oakland Hospital, in Pontiac, Michigan, the integration of people, processes, technology and culture is already underway. Using aspects of the available technology and that to come in later phases, St. Joseph is literally transforming the way the emergency department works. One of the goals is to consistently meet a promise of 20 minutes or less to see a physician.

The Emergency Department’s New Process

Pam Wietecha, RN, clinical leader, at St. Joseph Mercy Oakland Hospital spoke about the changes to the emergency department procedures enabled by Genesis.

Designing a process to meet the “20-minute promise” took a multidisciplinary, collaborative group including nurses, physicians and ancillary personnel from the emergency center, registration and short-stay areas.

A typical scenario might be as follows: A patient comes into the emergency center. Patients with chest pain, stroke symptoms or other apparent urgent complaints are taken directly to a treatment room. Typically, within five minutes of arriving, patients with non-life-threatening complaints are quickly registered, the intake process is completed and they are taken to a treatment room. The registration starts the length-of-stay counter.

The registration system sends information to the tracking system and places the patient in the waiting area. As the patient moves to the exam room, the tracking system is updated. Anywhere in the department, staff can track patients’ movement and see who is waiting.

In the new process, the triage assessment is completed in the treatment room. The nurse and the physician will meet in the treatment room together with the patient. This represents a change in the way the work is done.

Nurse charting has changed. Focused assessment charting is documented in real time in the computer. Although this is a new task for many of the staff, it has been largely well-received. As a byproduct of real-time charting, caregivers now have the capability to look up what care has been done.

Effects of the New Process

The new process has had a number of effects on patient safety. The computer system houses information about previous medical/surgical history, attending physicians and demographic information. The care team can retrieve this information from anywhere in the emergency center.

Caregivers have access to a list of home medications at a glance. The medication reconciliation process is documented and can be viewed by the care team. Allergies, including an indication of “addressed or not addressed” are charted. A patient’s height and weight are available for the care team and can easily be used for medication calculations.

In the event the patient is admitted, caregivers on the patient care unit have access to the information about the emergency department activities and results in advance of the patient arriving on the unit. This has the potential to prevent repeat labs and affords the caregivers an opportunity to prepare.

The biggest change for the nursing staff is the arrival and use of the technology. Nurses are now charting in the exam room on a computer. To assist in the implementation, staff went through training sessions.

Some users were trained as “superusers.” Superusers are available on all shifts in the emergency center. Superusers meet once a month for training and updates to support the staff. Training manuals were distributed to all staff in training sessions, and reference sheets were posted to help assist with new information.

Recent evidence of success with both the caregivers and the patients has been demonstrated. During a computer outage, the caregivers expressed missing the system and remorse at having to complete their work with the old tools. Patient satisfaction is also on the rise.

The goal is to meet the 20-minute promise consistently. Barriers to achieving that promise have been identified. Inpatient bed availability requires patients to be held in the emergency department. A rapid influx of emergency patients and staffing can also be impediments.

Efforts will continue to remove the barriers and meet the time commitment every time. The next big process change will come with the implementation of computerized provider order entry.

Take-away Message

“Embrace the technology, it is not going away; the electronic medical record is definitely the wave of the future,” Wietecha concluded. “In the long run it is helpful to distribute information to everyone and rapidly share information.”


Project Genesis Unites Hospital System

Trinity Health

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