In this Issue

• Employee & Patient Satisfaction Affects Patient Flow
• Best Practices: Improving Patient Satisfaction & Empowering Staff: Sun Health's "Build a Bridge" Program
• Innovations: Streamlining Care Processes: Reston Hospital Center's "No Triage" Program
• Perspectives: Employee Satisfaction: Key to Driving Performance Excellence
• In the News: The Joint Commission Releases Bulletin on Standard MM 4.10
• New Reports: National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary, AHA Survey of Hospital Leaders, Press Ganey Emergency Department Pulse Report, Commonwealth State Report Card
• Announcements: Urgent Matters Team Collaborates with RAND to Assess Emergency Care in Washington, DC 

Employee & Patient Satisfaction Affects Patient Flow

Patient and employee satisfaction are increasingly becoming a high priority for leadership in hospitals and health systems. It is no surprise that research shows that both employee and patient satisfaction go hand in hand. Hospitals throughout the country are recognizing that employee satisfaction is key to patient flow, and efficient patient flow is key to patient satisfaction.

This e-newsletter highlights a hospital program specifically aimed at increasing both employee and patient satisfaction in the emergency department (ED) as well as a hospital that focused on bettering relations between ED staff and inpatient units, where tensions commonly reside. Additionally, a former Malcolm Baldrige Award recipient speaks about the rewards of health care organizations engaging in meaningful projects focused on employee satisfaction.

Best Practices
Improving Patient Satisfaction & Empowering Staff: Sun Health's "Build a Bridge" Program

At Sun Health Del E. Webb Hospital, ED clinicians redesigned their care processes to accommodate rapid growth in patient volume. To decrease wait times, the traditional nurse triage assessment has been replaced by a "quick-look" personnel tech that checks patients' vital signs and then sends them to a treatment area, where an immediate assessment is performed by a physician and nurse. ED nurses, led by Noreen Vanca, then launched the "Build a Bridge" program to reach out to their counterparts in other departments to explain the new ED system. Working together, ED and inpatient staff developed strategies to ensure seamless transitions between units and address any problems that arise. The approach is a simple, low-cost way to encourage communication and collaboration among hospital departments.

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Innovations
Streamlining Care Processes: Reston Hospital Center's "No Triage" Program

Faced with crowded waiting rooms and dissatisfied patients, EDs are looking for new ways to streamline their care processes. One innovative model for small community hospitals struggling with crowding, deemed "no triage," eliminates the initial step during which ED staff performs a comprehensive assessment of patients' needs. All arriving patients are immediately seen and either treated and discharged, given initial workup or treatment, or admitted to the hospital. Trials of this approach led by Teresa Kreider at Reston Hospital Center, in Reston, VA, have had impressive results: wait times fell dramatically, and satisfaction increased among staff and patients.

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Perspectives
Employee Satisfaction: Key to Driving Performance Excellence

Retaining high performing talent in todays healthcare environment is crucial to an organization's ability to effectively compete, provide the highest quality and safest care, gain system efficiencies, and achieve bottom line results. Debbie Cardello, who served on the executive management team of Robert Wood Johnson University Hospital Hamilton, a recipient of the 2004 Malcolm Baldrige National Quality Award, explains that employee satisfaction is a critical consideration in the quest for hospital excellence.

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In the News

The Joint Commission Releases Bulletin on Standard MM 4.10
The Joint Commission released a bulletin on Standard MM 4.10 in the Emergency Department. This standard required a retrospective review of all medication orders in the emergency department by a pharmacist when a prospective review was not conducted. The bulletin states that the standard is suspended based on several concerns cited by the field, including the lack of prior hospital pharmacist involvement in the ED setting, the cost to hospitals of providing additional pharmacist manpower to support medication review of any type in the ED, and the frequent unavailability of pharmacists given the long-standing pharmacist shortage.

New Reports

National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary
In June 2007, the Centers for Disease Control and Prevention released results from the National Hospital Ambulatory Medical Care Survey, including the Emergency Department Summary. The survey found that during 2005, an estimated 115.3 million visits were made to hospital EDs, which represents a 31 percent increase over 1995. Approximately 43 percent of patients were considered "urgent" or "emergent" and approximately twelve percent of ED visits resulted in hospital admission.

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AHA Survey of Hospital Leaders
The American Hospital Association released findings from the 2007 AHA Survey of Hospital Leaders in July 2007. The survey highlights conditions in emergency departments across the country, citing that nearly half of EDs are "at" or "over" capacity, with a majority of urban hospitals experiencing time on diversion. Hospital leaders cited a lack of staffed critical care beds as the most common reason for diversion.

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Press Ganey Emergency Department Pulse Report
Press Ganey recently released its Emergency Department Pulse Report 2007: Patient Perspectives on American Health Care. Key findings include: overall patient satisfaction with the ED increased between 2003 and 2006; the more patients an ED sees, the less satisfied the patients; and the average time a patient spends in the ED is four hours.

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Commonwealth State Report Card
In June 2007, The Commonwealth Fund issued the State Scorecard on Health System Performance, which follows the National Scorecard on U.S. Health System Performance, published in 2006. The State Scorecard assesses variations in health system performance between states in the U.S. by access, quality, avoidable hospital use and costs, equity, and healthy lives. Key findings include: across states, better access is closely associated with better quality; there is wide variation among states, meaning that there is potential for the country to do much better; and higher quality is not associated with higher costs across states.

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Announcements

Urgent Matters Team Collaborates with RAND to Assess Emergency Care in Washington, DC
Staff from Urgent Matters have recently joined The RAND Corporation to assess emergency and urgent care in the District of Columbia. The study is in response to legislation voted on by the D.C. Council and is overseen by the Office of the City Administrator. The study will assess both emergency medical services (EMS) and emergency departments throughout D.C. Urgent Matters staff plans to release a report with findings and recommendations in spring 2008.