Emergency Department Process Improvement Program

"Using the improvement methodology, we were finally able to start and sustain flow initiatives instead of continually starting and stopping."

Scott Jarrett
Executive Sponsor
Vice President, Patient Services
Humber River Regional Hospital

The ED PIP Experience...

Emergency Department Process Improvement Program (ED PIP) hospital sites have dealt with many of the problems that you are likely experiencing at your hospital. The vignettes below, from the perspective of key stakeholders, will help you to get a feel for how you can accomplish the results that Ontario ED PIP hospitals have worked hard to achieve.

As a Physician... I value that my input and opinion matter to the team, and that they recognize my efforts and participation, which frequently occurs during my own time. I recognize improvements in quality and safety which helps me to improve my patients’ overall hospital experience. The process improvement program provides a structured approach for helping our hospital team raise the bar around quality and patient safety performance, as well as eliminating a lot of frustrations from our working environment.

As a Senior Executive... I feel comfortable knowing that as an organization, we are building capacity to sustain improvement and manage change in the future. PIP is a great way to kick-start our hospital to shift our culture to be more results focused and comfortable with performance improvement, quality improvement and continuous change.

As a ED PIP team lead... I feel like the organization has put a lot of faith in me and through PIP has provided me with the skills I need to lead improvement initiatives. I also feel that I have been given an opportunity to develop my skills and leadership abilities which will help me throughout my career.

As a front line staff... I’m being asked for my opinion and my suggestions are being adopted. I feel like we can agree or disagree with each other, but through our experience with PIP, we have a common goal and we’ve started to become comfortable with change.

Program Impact

The ED PIP has helped hospitals focus on the root causes of their patient access and flow problems and develop relevant solutions/interventions. The table below profiles selected interventions that resulted in a significant improvement in ED Length of Stay (ED LOS) at participating hospitals.

Intervention	Description	Impact
Creating a “See & Treat” model of care	A model of care in which ambulatory patients are seen in a dedicated zone of the ED This reduces the wait before seeing a physician (2 - 2.5 hours) by eliminating redundant steps in the process and leveraging non-physician staff	Hospitals that have implemented See and Treat models of care have seen reductions of up to 2 hours in their ED LOS for 30-50% of their patients
Match Staffing to Demand	Most Emergency Departments see a rapid increase in demand early in the morning, while physician staffing doesn’t typically ramp up until mid afternoon at which point there is a large “backlog” of patients to be seen	Correctly staffing to demand can have a strong impact on 90th percentile metrics, as delays often occur when mismatches exist
Reducing “Bed Empty Time”	Many hospitals will have inpatient beds sit empty for 4-6 hours given the large number of people involved in getting the next patient in (housekeeping, nursing, admissions, portering)	By clarifying roles and accountabilities throughout the process and developing a more streamlined process hospitals have reduced the bed empty time from 6 hours to 1 - 1.5 hours This creates capacity for patients waiting for a bed in the ED
Implementing Predictive Discharge Processes	Often patients have to stay from 6-12 hours after the discharge order from the physician has been signed, given administrative delays (preparing transportation, advising family, etc.) By developing a set of changes that improve daily communication across the care team, patients are prepared for their discharge and length of stay is reduced	Similar to reducing Bed Empty Time, by reducing the Length of Stay on the unit, inpatient bed capacity is created for admitted ED patients Hospitals have been able to reduce inpatient unit LOS by 5-10% once an effective Predictive Discharge process is put in place – this ‘unlocks’ a similar portion of the unit’s beds (i.e. fully staffed and equipped beds)

A sample set of ED LOS results indicate a clear improvement at ED PIP hospitals for both 4 and 8 hour targets. The following two graphs provide a visual representation of the data over an 8 month period.

High Acuity Patients

Low Acuity Patients

"This is the first time in my 32 year career that I feel that I can make a difference and change things. PIP has allowed me to do this."

Susan Faulkenham
Registered Nurse, Soldiers’ 1
ED-PIP Team Member
Orillia Soldiers’ Memorial Hospital

Success Stories

Click below to view detailed case studies that describe actual hospital experiences with process improvement during pilot and during the ED PIP program. Learn what worked and did not work for these hospitals and get a glimpse into what they would do differently if they had the chance and how they plan to spread and sustain the improvement results they achieved.

Note: These are pdf files. PDF reader, such as Adobe Acrobat Reader, has to be installed to read these files.