Best Care in Action: Curing ER wait times

Jul 17, 2017, 09:22 AM by KirstiAnn Clifford
Christine Wade (right) and Pam Cruz (4th from left) with members of the Emergency Department care team.
Crowding in the emergency room and long wait times seem to be the “norm” at hospitals across the country.

But Christine Wade and her colleagues in UTMB’s Emergency Department on the Galveston Campus are working hard to change that perception, from the moment a patient walks through the door to the moment they are discharged.

“How long it takes to get people through the ED is probably one of the biggest dissatisfiers or satisfiers for patients and staff,” said Wade, director of Patient Care Services and assistant chief nursing officer for Emergency Services. “People come to the ED thinking they will have to wait a really long time, but that doesn’t happen in our ED. We now average five minutes from the time you arrive to the time you are in a patient treatment area, which is an incredibly short number.”

In fact, UTMB’s ED recently ranked No. 2 out of 44 reporting members for Emergency Department Length of Stay, according to the Vizient Vitals in Performance Q4 2016 results.

Whether being discharged home or admitted to a hospital unit, wait times and length of stay in the ED have decreased—while patient satisfaction has increased. For example, ED patients who are admitted to the hospital now spend an average 5.2 hours in the ED (from the moment they arrive to when they leave to the appropriate hospital unit). That’s improved from 8.5 hours back in January.

In addition to her staff’s competitive nature, Wade credits several initiatives over the last few years for the improvements in patient throughput, including building partnerships with several inpatient areas to ensure patients get to their correct destination more quickly.

“Patient throughput in the ED is not just an ED problem, it is a hospital-wide problem because once the hospital starts backing up somewhere, it just spills down and you see it in the ED,” said Wade. “A lot of the work we’ve done has been collaborative with the whole hospital. We’ve really developed relationships with inpatient nursing, radiology, transport—it’s been a huge group effort to educate and communicate, and we are finally seeing the fruits of our success.”

Pam Cruz, ED nurse manager, added, “This is all about what’s best for our patients. Patients don’t want to wait—the ER is not the place for you if it’s been decided that you need to be admitted. If you are an ICU patient, the best place for you is the ICU. If you are a dialysis or transplant patient, the best place for you is on the transplant floor, not sitting in the ED. Plus, we need to make room because there are probably four other people waiting for your spot.”

The department, which is on target to see about 45,000 patients this year, recently adjusted staffing based on the busiest days and times of the week, and holds quick meetings each day between nurses and physicians to “run the boards,” or review the status of each patient and delegate tasks. Another initiative that has helped cut down length of stay involved working closely with the Department of Pharmacy. By stocking a medication-dispensing machine in the ED with commonly needed drugs, patients no longer have to wait for the central pharmacy to process each order and deliver medication to the unit.

Wade and Cruz hope the ED team can keep up the momentum, and reach No. 1 for length of stay among EDs in the near future. When that happens, they will bring in a cotton candy machine to celebrate “how sweet it is.”

“Our staff is motivated by two things: food and competition,” laughed Wade. “But seriously, it’s so important to celebrate every little success and milestone reached. I’m so proud of the staff and their commitment to taking care of patients as effectively and efficiently as possible.”

Galveston Campus recertified as Level 1 Trauma Center

The Galveston Campus has been recertified as a Level I Trauma Center by the Verification Review Committee of the Committee on Trauma of the American College of Surgeons.

This achievement recognizes UTMB’s dedication to providing optimal care for injured patients. UTMB is one of only 19 Level I trauma centers in the state and one of four in the Houston-Galveston region. UTMB is also the only Level I trauma center in a nine-county East Texas service region.

“UTMB has a long history of taking care of patients after catastrophic disasters,” said Dr. William Mileski, chief of trauma services and co-director of the Emergency Department at UTMB’s Galveston Campus. “The reason we are still here and able to provide this high level of care is due to the hard work and dedication of the men and women who come in day and night ready for any emergency.”

UTMB was first designated as a Level I trauma center in 1999 and was considered one of the best in the nation. Hurricane Ike in 2008 caused UTMB to lose the designation, but the university officially regained its top level trauma center status in 2011 and has been continually recertified since then. UTMB’s Angleton Danbury Campus is certified as a Level IV Trauma Center.