Children's Hospital Central California

The Children's Hospital Central California Emergency Department, with over 55,000 annual visits, was receiving negative feedback from Press Ganey patient surveys and from the medical staff. The numerical study feedback represented low service markers, as represented by long patient length of stay, low staff morale, and a very unhappy patient community. The hospital administration as well as the clinical work force knew that the old standard of "work harder" and "smile more" just wasn't going to cut it.

In early 2006 a new EPMG Medical Director stepped in and along with the existing assistant director, approached the problems together with a focus on improvement.

EPMG's Medical Director, in addition to overseeing the entire department, took steps to address the various system problems. Initially he focused the physicians on patient satisfaction by providing monthly feedback on scores and by spending time in the monthly meeting reviewing feedback, both good and bad. The ED patient reps also copied all positive Press Ganey surveys and shared them with both nurses and physicians.

Also needing to improve overall throughput time and time from triage to bed, the Director formed three new committees in the ED with Nurses, Emergency Service Technicians and Registration. Each committee focused on how they could improve the measurable times in the ED and to
continue to improve patient satisfaction. They worked on the general patient flow, peak hour obstacles, and all process solutions.

The work of the three committees resulted in many positive changes throughout the department. Although each had an area of focus, they collaborated with administration as well as the other physician, nursing and clerical staff to develop and implement many of the ideas.

A dedicated Fast Track was established in the ED and additional Pediatricians were hired to staff this area. This added more beds to the ED and allowed minor emergencies to be seen more quickly; the patients who in the past left before being seen because of long wait times. The Fast Track coverage was also expanded from 8am - 4am.

The Triage Committee formed the policy of "Open Beds Means Empty Triage." A primary triage with a brief screening exam is performed by a nurse and the patient is taken to a bed, if available, where the rest of the triage is completed. This effort led to a dramatic decrease in "Left Without Being Seen" to less than 1%, far below the national benchmark for an ED of this size.

Press Ganey reported an impressive move from the 3rd percentile (3/06) to the 92nd percentile (2/07) for the main Emergency Department. ED remodeling initiated in mid 2007 resulted in a fairly predictable set back in patient satisfaction, though our overall status continues to rise again. Most importantly, we have improved our image in the eyes of the community by providing necessary services with high-quality medical care, decreased time parameters, and significantly increased patient satisfaction scores.

As leaders, we know we are headed in the right direction. Improvement of services leads to improved community relations which means enhanced job satisfaction, and thereby improvement of staff retention and recruiting. This is the "Best in Emergency Medicine" in practice at Children's Hospital Central California.