How One Hospital Transformed Their Emergency Room

Few have ever been inclined to praise their experiences in the ER. In fact, Emergency Rooms seem to be one of those unavoidable, groan-worthy survival experiences that everyone has to face in life. Like acne, for instance.

Most of us have visited the ER at least once, and the stories afterward usually consist of comparing notes on the noise, the smell, or the excruciatingly long wait time. “Oh, only 4 hours? You were lucky. I was there for a full 6 before getting a room.” Etc., etc. Many of us recite these experiences like old war vets remembering a particularly grizzly battle. Voices and all, on occasion.

But what if it could be different?

One hospital dared to hope that it could be. In 2012, the University of Colorado School of Medicine and Hospital recruited a new chair and adopted a new mission: “Build an academic department of emergency medicine, and prepare for a much-needed [Emergency Department] ED expansion.”

The new chair, Richard Zane, MD, had his work cut out for him. The list of problems he faced included health code violations and complaints, a near constant need to divert ambulances (at least 8 of every 24 hours), and a complete lack of faith and standing from both patients and other healthcare professionals within the community.

When they began their revitalization effort, the University of Colorado Hospital was basically the laughing stock of the area, as competing hospitals benefitted from the patients who left without care because of excessive wait times and other medical professionals in the surrounding area hesitated to refer patients their way.

By the end, however, Zane and his team had created a whole new way to approach ED management.

As of December 2015, patients at the University of Colorado Hospital waited an average of 8 minutes to see an attending physician, volume had increased by 53 percent, and patient-satisfaction scores were “in the top box” 77 percent of the time. The level of turn-around that Zane and his team managed within only two short years is nothing short of amazing.

So how did they do it?

According to Zane, the metamorphosis required 6 vital methods of approach:

  1. A patient-centered focus. When Zane and his staff discussed what changes were needed, they agreed that the key was to make sure “every single process, change, movement, and piece of equipment existed because it was better for the patient, not the convenience of the provider.” If a change could not be explained in terms of how it benefitted the patient, it was immediately discarded.
  2. Dedication to the data. To ensure complete accountability, Zane and his team measured everything that might affect patients and used those numbers to set a standard and then spread that information to all parties, setting up a system of accountability and expectation for meeting higher goals.
  3. Unity in purpose and execution. While various opinions were welcomed in the brainstorming stage, once a decision was made, everyone adhered to and dedicated themselves towards the execution of that goal. Presenting a united front can have a pronounced impact, especially in terms of patient satisfaction and confidence.
  4. Open minds to different perspectives. All positions and roles within the hospital were taken into account and given equal value. Suggestions for changes were considered based on their merit for helping the patients, not the position of the speaker in the hospital’s hierarchy. Every voice has a unique perspective and value, and each can contribute differently to improving a patient’s experiences.
  5. High quality care across all roles and disciplines. By educating all ED staff members about key high risk factors and identifying specific “care pathways” for the use of resources and guidance in establishing the appropriate steps for care, Zane and his team were able to cut costs of care per patient by 18 percent. Utilizing the knowledge of specialists and spreading that knowledge to ensure confidence and a high level of knowledge among all care providers within the department actually improved overall decision-making and care processes.
  6. Setting the bar high. Meeting the standard of excellence is the goal of any organization, but Zane and his team have sought to “set the standard” by creating a new example and re-envisioning the emergency care process. In doing so, they’ve established a higher standard of excellence that other institutions are now aspiring to.

The most important thing that Zane and his team demonstrated during their two-year overhaul of the emergency department at the University of Colorado Hospital: doing the same old thing is no longer going to fly. Bigger is not always better, and more money isn’t the key to great improvements. Great improvements come from great minds working together openly and discussing new ways to re-envision an old need.

As you consider how to improve your practice, how to make changes for the better—big or small—start with your vision and your methods before you spend a single dime. Your facilities might not be the problem.