St. John Hospital and Medical Center

PerfectServe Plays Key Role in Helping Busy ED Reduce LOS

St. John Hospital and Medical Center is a major tertiary care center with an annual Emergency Department (ED) census that has grown 15% in two years to more than 108,000 patients. To reduce overcrowding, St. John developed a comprehensive strategy to improve ED patient throughput and efficiency.

The hospital’s key strategy was to establish ED-managed Clinical Decision Units (CDUs) to provide a bridge between the ED and St. John’s inpatient services. These units require close collaboration between various providers and clinical personnel, both within and outside the hospital. Since CDU stays cannot exceed 24 hours, inefficiencies and delays in communications related to CDU patients had to be eliminated.

To facilitate timely, error-free clinical communication, St. John implemented the PerfectServe clinical communications system so that calls and messages would be routed to the right clinician at the right time in the right way, based on each clinician’s preferences and the clinical situation. PerfectServe establishes a highly efficient, standardized and documented method to reduce variability in the clinical communications process and enable clinicians to improve their coordination of care.

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40% reduction in ED LOS from door-to-inpatient bed

The ED LOS from door-to-inpatient bed for admitted patients was reduced from more than 10 hours to less than 6 hours.

40% Reduction in ED LOS from door-to-inpatient bed

We’ve done a number of things to reduce length of stay, and improving communications through PerfectServe has played a major role in our efforts.”

Dr. Robert Takla
Medical Director and Chair, Emergency Medicine

22% reduction in average time from patient’s CDU arrival to the decision to admit

The average time from a patient’s CDU arrival to the decision to admit was cut from 21.5 hours to 16.6 hours during the first year.

22% Reduction in Average Time from Patient's CDU Arrival to Admit

ED Communication Objectives

  • Eliminate variability in clinical communications by standardizing the ED clinical contact process.
  • Facilitate faster, more efficient collaboration among clinicians to improve the coordination of care.
  • Support the ED’s efforts to reduce patients’ length of stays (LOS).

Actions

  • Raised awareness of the importance of departments’ active participation in achieving ED throughput goals—a cornerstone of patient safety and satisfaction.
  • Implemented the PerfectServe clinical communications system that automatically routes calls and messages according to every provider’s workflow rules, call schedules and contact preferences.
  • Used PerfectServe to:
    – Standardize contact methods for physicians involved in treating ED and CDU patients.
    – Capture information for all communication events..

Results

  • By increasing communication efficiency and reducing communication variability with both facility-based and on-call providers, PerfectServe contributed to the success of St. John’s ED throughput initiative, which enabled the hospital to:
    – Reduce ED LOS from door-to-inpatient bed for admitted patients by more than 40 percent (from more than 10 hours to less than 6 hours).
    – Cut the average time of a patient’s CDU arrival to the decision to admit by more than 22 percent (from 21.5 hours to 16.6 hours).
    – Reduce ED LOS from door-to-discharge for patients not admitted to the hospital by more than 10 percent (from 3.5 to 3.1 hours)..
  • Physician satisfaction increased because doctors could exercise more control over how they were contacted by the ED.
  • Data from the PerfectServe system helped the ED develop a Continuous Quality Improvement (CQI) process related to provider communication and tracking.

Keys to Success

  • Administrative leaders who recognized that ED patient flow is a hospital-wide issue and reinforced its importance.
  • Gaining the support and active involvement of department heads, physicians and staff members.
  • Listening to the medical staff and providing them with tools that made it easy to accept and adopt new communication protocols.
  • Enabling physicians to selectively filter and prioritize ED calls from those originating from other departments.
  • Maintaining an ongoing dialogue with the medical staff and refining processes to meet their needs.

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Client Quotes

PerfectServe has helped us improve patient flow and efficiency throughout the ED. Without all the delays in reaching physicians, we can now move more quickly on the disposition of patients.”

Dr. Robert Takla
Medical Director and Chair, Emergency Medicine

PerfectServe makes it easier for our ER Health Unit Coordinators to contact physicians and track their response times. If there’s ever a question as to continuity of care or an issue of patient safety, we now have one ‘source of truth’ about what happened.”

Stephen Kler
Manager Clinical Informatics & Support Services

I’ve used PerfectServe as a practicing orthopedic surgeon and like how it gives me direct contact with the ED, the nurses on the floor and the physicians requesting consultation. It has not only improved physician satisfaction, but has also eliminated errors and delays that increase patient safety risks.”

Dr. Michael Haynes
Chief Medical Officer