30 Minute ER Promise: Changing the Public's Perception of Emergency Care in Worcester County

Three weeks after implementing a 30 Minute ER Promise, Atlantic General Hospital associates will tell you that they really can’t see any change in the way patient care is handled. Visitors to the emergency room are met at the door by a registrar with a tablet PC to discuss their symptoms, they are assessed, they are treated and they are discharged. Health care as usual.

That’s because Atlantic General Hospital has been preparing to launch this program – a commitment to the community to place ER visitors in a treatment room or initiate their treatment within 30 minutes of arrival – for more than a year. Both technological and procedural improvements have been made hospital-wide to increase efficiencies in the emergency department.

• Pneumatic tube system, such as the one used in bank drive-thrus, delivers specimens quickly to the laboratory for analysis. The results from those samples are then available in the department’s computer system and automatically faxed to the doctor’s station.
• PACS (Picture Archiving and Communications Systems), a digitized radiology system allows the emergency staff to see images on the computer as soon as the x-rays are taken. There is no wait for film to be developed and delivered before a patient can be diagnosed.
• The Automated Medication Dispenser (PYXIS) keeps medication on-hand in the emergency department based on previously reported usage. This assists in reducing patient treatment times because the ED staff doesn’t have to wait to receive the medication from the pharmacy. A patient’s name is pulled up on the system, a medication is selected, and it is available immediately.
• Patient Tracking System. As soon as a patient enters the emergency department, a staff member with a handheld PC is logging that individual’s reason for coming in. The information entered into the handheld appears on the computers within the department, allowing the medical staff to make note of symptoms before the patient enters the room.
• Separate Fast Track for those patients with minor injuries or illnesses who can be treated more quickly. From the time of arrival to discharge, fast track patients spend an average of one hour and fourteen minutes in the department.
• Peak Flow Scheduling. Patterns in patient flow were identified and staffing altered accordingly. One example is the timing of inpatient discharges, which tend to occur during the morning. Therefore, administrators increased the hospitalist staffing in the morning to discharge patients; they also arranged for more housekeeping staff during the afternoon to provide fresh linens and ready rooms for patients during the evening hours when most admissions occur.
• New Admissions Procedure. The traditional admission process for emergency patients requires a wait time until the admitting physician (hospitalist) can come to the emergency room to assess the patient. With the new procedure, the hospitalist receives a telephone communication directly from the emergency physician, a few orders regarding care are exchanged, and the patient is expedited to a private room. The hospitalist will then visit the patient in the comfort of his or her room. This prevents a bottleneck in the emergency department as patients wait to be assessed.
• Interdisciplinary Rounds. An interdisciplinary team that includes the hospitalist, charge nurse, patient care supervisor, pharmacist, case manager, patient advocate, and other disciplines as necessary makes morning rounds to every inpatient at the hospital. These rounds are used to coordinate a plan of care to establish the next steps for transfer or discharge.

The changes were instituted to improve patient outcomes and make the emergency room crisis that has gripped the nation irrelevant in Worcester County.

So, while nothing really changed on February 1 when the program was launched, the 30 Minute ER Promise has served as a vehicle to educate the community about the kind of care they can expect to receive at Atlantic General Hospital. During the trial phase, the emergency room was meeting its 30 minute goal 98 percent of the time.

In its first 21 days, the goal was missed only once. But, the individual who had to wait just a little longer than the other 1,363 visitors showed both surprise and pleasure when presented with a gift certificate for a local establishment. The gift, it appears, really was not necessary.