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Views from the Field: Inova Fairfax Hospital
Inova Fairfax Hospital (IFH) is Inova Health System's flagship hospital. This nationally recognized, 1,000-bed regional medical center located in Falls Church, Virginia, is consistently ranked among the top health care providers in the nation. Inova Fairfax Hospital is Northern Virginia’s only Level 1 trauma center; the emergency department (ED) receives over 100,000 patient visits annually.
In 2003, IFH was selected to participate in the first Urgent Matters Learning Network. As part of the year-long project, IFH’s Urgent Matters team set out to reduce ED wait times and increase patient satisfaction by creating physician and nurse teams dedicated to providing effective and timely triage as patients arrived in the ED. The Urgent Matters team also developed and implemented processes for addressing crowding and boarding in the ED through programs called Adopt-A-Boarder.
In 2003, IFH’s ED was grappling with a problem that EDs across the country continue to struggle with: lack of capacity. Facing an exponentially growing volume of patients and limited resources, IFH looked for outside help to tackle the issue; Urgent Matters could not have come at a better time. "We're fortunate in that Inova is an organization that innovates frequently," says Thom Mayer, MD, FACEP, FAAP, President and CEO, BestPractices Inc., former Chair of Emergency Medicine, Inova Fairfax Hospital, Urgent Matters project Director.
Team Triage and Treatment: Mayer and his team established a team triage program, developing advanced protocols to front-load triage care in the ED, Mayer explains, “Most patients believe that an ED visit begins when they see the doctor.” The triage team is comprised of an ED physician, nurse, scribe, emergency technician, and a registrar. The five member team works together and begins an ED patient's evaluation and treatment at their first point of contact. The scribe records everything the physician says and the technical assistant completes multiple tasks, such as order-entry. A registrar expedites care by registering patients into the IFH computer system.
Team triage was first launched as a pilot with limited hours. To appropriately evaluate the program's effectiveness, Dr. Mayer and his team began tracking a number of data sources, including patient surveys, staff surveys, chart reviews of turn-around times, a cost-benefit analysis, reports on patient safety occurrences, amongst others. The implementation of team triage, which is still in use today, had a significant impact on patient flow at IFH. Throughput time for patients seen during team triage operation hours were reduced by 64%, and throughput time for the entire ED was reduced by 15%. Patient and staff satisfaction scores were increased and left-without-being-seen rates decreased. Mayer also found that physicians treating patients as part of the triage team ordered fewer labs and imaging, and saw more patients during a shift. “I'd say team triage has been somewhere between very successful and spectacularly successful," said Dr. Mayer.
Adopt-A-Boarder: Adopt-A-Boarder is a capacity building protocol designed to expedite the process of inpatient admissions and discharges. IFH has a number of processes in place that facilitate the transition of patients from the ED to inpatient units; however, the inpatient occupancy rate often exceeds 100 percent. Adopt-A-Boarder is activated when the ED reaches maximum capacity. Patients are assigned to their unit of inpatient care, even though their bed may not be ready. “The hospital has become to attuned to the needs of ED patients, beds are typically found prior to the activation of Adopt-A-Boarder,” said Mayer, but these and other capacity building processes have improved patient flow through the ED and across the hospital.
Team triage was first launched as a pilot with limited hours. To appropriately evaluate the program's effectiveness, Dr. Mayer and his team began tracking a number of data sources, including patient surveys, staff surveys, chart reviews of turn-around times, a cost-benefit analysis, reports on patient safety occurrences, amongst others. The implementation of team triage, which is still in use today, had a significant impact on patient flow at IFH. Throughput time for patients seen during team triage operation hours were reduced by 64%, and throughput time for the entire ED was reduced by 15%. Patient and staff satisfaction scores were increased and left-without-being-seen rates decreased. Mayer also found that physicians treating patients as part of the triage team ordered fewer labs and imaging, and saw more patients during a shift. “I'd say team triage has been somewhere between very successful and spectacularly successful," said Dr. Mayer.
Adopt-A-Boarder: Adopt-A-Boarder is a capacity building protocol designed to expedite the process of inpatient admissions and discharges. IFH has a number of processes in place that facilitate the transition of patients from the ED to inpatient units; however, the inpatient occupancy rate often exceeds 100 percent. Adopt-A-Boarder is activated when the ED reaches maximum capacity. Patients are assigned to their unit of inpatient care, even though their bed may not be ready. “The hospital has become to attuned to the needs of ED patients, beds are typically found prior to the activation of Adopt-A-Boarder,” said Mayer, but these and other capacity building processes have improved patient flow through the ED and across the hospital.
Mayer says that patients across the country have benefited from Urgent Matters projects, even though many “have never heard of it,” he says. “Improving patient flow improves patient safety, patient outcomes, staff satisfaction, and the financial bottom line.”
Thom Mayer, MD, FACEP, FAAP, CEO, BestPractices Inc.
