Hospital Administrators :: RME :: Case Studies
CEP America's RME Program is revolutionizing patient flow and ED efficiency throughout the nation at a wide variety of sites - large, small, public, private, and teaching.
The following case studies are just some of our RME success stories. For more information on CEP America and RME, call 800.476.1504.
St. Mary Medical Center
St. Mary Medical Center, located in the high desert in Apple Valley, California, is a Level II, 186-bed acute care hospital that treats over 50,000 emergency department (ED) patients annually and is among the first CEP America sites to implement an RME program. Upon being awarded the contract in early 2003, CEP America conducted an operations assessment of St. Mary’s ED to identify any problem areas or issues affecting ED patient flow and services. As a result of this assessment, a multidisciplinary Triage and ED Efficiency Task Force was formed to create an expedited medical screening process.
Six months after CEP America was awarded the contract, St. Mary had completely reengineered its front-end process and implemented an RME approach. The ED experienced a 75% decrease in time to provider (TTP) from 87 to 22 minutes, an approximate 60% decrease in total turnaround time for discharged patients from 360 to 143 minutes, and a decrease in the percentage of patients who left without being seen (LWBS) from 10.6% to almost 1%. Meanwhile, patient satisfaction scores increased dramatically from the 25th percentile in Q1 2003 to the 70th percentile in Q2 2003.
As of spring 2007, St. Mary has been able to maintain these operational and patient satisfaction improvements since the introduction of RME by re-engineering the process with a new provider at triage area to accommodate the growth in patient volume. Its current TTP is 24 minutes and the percentage of LWBS patients remains extremely low at 1.5%. Patient satisfaction has continued to improve and St. Mary ranks 3rd on this metric out of CEP America’s high volume sites. St. Mary has also achieved vast improvement in diversion hours since implementing RME, which has been slashed from over 328 minutes per month to 26 minutes per month. At CEP America’s 2004 Partnership Meeting, St. Mary was awarded the ED Operational Excellence Award. In 2006 the site again received recognition for its sustained performance with an ED of the Year Award.
Back to Top
Arrowhead Regional Medical Center
Arrowhead Regional Medical Center, a public, 373-bed hospital, has one of the busiest EDs in California, with approximately 100,000 ED patients treated every year. That is more than any other ED in San Bernardino, Riverside, San Diego, or Orange counties. Yet, thanks to the recent implementation of RME, the wait times for Arrowhead patients were significantly lower than wait times at most EDs with half as many patient visits. In fact, time to provider was cut in half from 80 minutes to 39 minutes. At the same time, patient satisfaction remained high and nearly 80% fewer patients left without being seen. Incredibly, Arrowhead’s ED providers and staff achieved these milestones even as patient volumes significantly increased by more than 15% over the course of two years. Arrowhead’s improved performance recently earned them a 2006 Distinguished ED Service Award from CEP America.
Arrowhead’s accomplishments become even more noteworthy when one compares the proportionally small investment the site made against their overall gain. As a county site, Arrowhead is required to adhere to union regulations and as such executing the minor improvements to their physical plant required to implement RME cost approximately $300,000. However, once the improvements were complete, Arrowhead was able to treat 100% of its non-ambulanced patients in just 15% of its available space. This enhanced throughput enables the ED to treat more patients, which in turn leads to increased revenue for the hospital as a whole, which over time will more than cover the costs for the physical plant improvements.
Back to Top
Madera Community Hospital
A 16-bed ED located in California’s Central Valley, Madera Community Hospital exemplifies successful RME implementation at a new contract site as well as sustained results. Faced with complex medical staff issues and an average wait time of greater than 60 minutes at the start of the contract in October 2003, the Medical Director, other physicians, midlevel providers, and nurses were highly motivated to initiate changes in the ED. As a first step to widespread improvement, providers and nurses met together as a leadership group and agreed that fostering better and more open communication with medical staff members would set the stage and create the credibility with hospital administration necessary to push for a sweeping change like RME implementation. Additionally, they recognized that reduced liability risk and increased patient satisfaction would naturally result from a more patient-oriented approach to treatment, including complete staff commitment to a 30-minute or less wait time. As such, the leadership group worked quickly with all providers and staff to develop the mindset of seeing patients quickly upon arrival and moved the registration process to the bedside.
Under Madera’s program, the RME process occurs 18 hours a day, 7 days a week, and the team consists of a nurse assistant, a technician, and a midlevel provider. There are three RME treatment areas in the ED, a setup which allows for immediate patient assessment, treatment, and discharge, when possible. As part of the program, the midlevel providers participate in an annual training session to ensure competency in addressing specific documentation criteria mandated by the state under Title 22 and to keep abreast of any new regulatory developments that could potentially affect the “arrival” sequence of a patient’s emergency course of care.
By the second month of the program, time to provider (TTP) had dropped to 15 minutes, 70% lower than the national average of 52 minutes. In November TTP reached an all-time low of 5 minutes, a mark that was sustained for 6 consecutive months. Total turnaround time decreased from 162 minutes to 110 minutes, and the rate of left without being seen (LWBS) patients fell from 3.5% to less than 1%. Ambulance diversion has also plummeted from 1,330 minutes per month to 107 minutes. News of Madera’s short wait time quickly spread by word of mouth as well as through a marketing plan aimed at educating the community. As a result, patient volume rose substantially, from 5,392 patients in Q2 2004 to 7,238 patients in Q2 2005; meanwhile, patient complaints decreased dramatically. Remarkably, despite the increase in visits, Madera has maintained an average wait time of 8 minutes across the first year of RME.
Currently, Madera has continued to build on its successful RME program, while patient volume remains on the rise. Patient satisfaction has reached an all-time high of 4.41 (out of 5) in part due to Madera’s impressively low TTP of 12 minutes in 2006. Madera won CEP America’s 2005 ED Operational Excellence Award in recognition of its achievements.
Back to Top
Kaweah Delta Healthcare District
Kaweah Delta Healthcare District is a not-for-profit facility located in Central California with a 23 bed emergency department. Although Kaweah is the 4th largest site in CEP America with an annual ED patient volume approaching 70,000, after implementing an RME program its average time to provider reached a record low in late 2006 of 22 minutes – well below the national average.
Prior to implementing its RME program this site determined some critical factors essential for the program’s success. One of which is to identify physician, nurse, and hospital administrator “champions” who will infuse the rest of the providers and medical staff with not only the technical understanding of the RME process, but also with their enthusiasm. Another key factor to successful RME implementation is clear communication coupled with a straightforward explanation of expectations and measures of success. In many cases, a change in attitude is necessary to achieve the flexibility each staff member must bring to a successful RME program.
After securing these crucial factors, Kaweah has made significant strides in its patient satisfaction scores, which have increased from 4.08 in 2005 to 4.27 in 2006 (on a scale of 1-5). Staff satisfaction has also increased dramatically; in a recent survey Kaweah’s nurses rated team and overall satisfaction a 5 out of 5. The ED has also decreased the number of patients who leave without being seen by nearly 65%, from 6% in 2005 to 2.12% in 2006. Moreover, in 2006 Kaweah boasted an incredible zero diversion hours. Kaweah’s impressive performance earned them a 2006 ED of the Year Award from CEP America.
Back to Top
St. Bernardine Medical Center
St. Bernardine Medical Center is a 433-bed acute care, not-for-profit facility that provides the full continuum of medical care to residents of San Bernardino and its surrounding communities. The 16-bed emergency department (ED) treats 42,000 patients annually with a 15% admit rate.
This particular ED identified its time to provider (TTP) as an area for improvement. A multi-disciplinary committee examined current operations to pinpoint ways to improve patient flow and networked with other CEP America sites to collect best practices by visiting sites and participating in Regional CEP America ED Leadership Meetings. Several innovative solutions were implemented with the goal of enhancing ED efficiency, including the integration of a Rapid Medical Evaluation Program©. In 2003, an RME team was established consisting of a physician provider, a triage nurse, and an ED Tech. This RME team immediately starts the treatment process when the patient arrives at the ED, beginning with an initial assessment by the ED provider; followed by the ordering of labs and X-rays; and, in some cases, rapid discharge.
Through its team approach, St. Bernardine’s ED has been able to successfully reduce its TTP from over 100 minutes to under 30 minutes, decrease its percentage of patients who left without being seen (LWBS) by 55%, and diminish its diversion hours per month by 75%. Furthermore, St. Bernardine achieved a virtual expansion of its ED with minimal up-front costs. After a small physical plant improvement of $15,000 to add two walls and a window of bullet-proof glass, St. Bernardine now treats approximately 50% of its patients in just 10% of its space. This improved efficiency in patient throughput far outweighs the initial investment costs and has the potential for significant long-term gains for the hospital as a whole.
Currently, St. Bernardine has continued to improve upon its preliminary success with RME and has even become a teaching site where staff from other EDs visit to observe and learn how to replicate the program’s success at their own site. TTP has continued to drop as have diversion hours. Patient satisfaction has also significantly improved and LWBS numbers remain low. Recently, St. Bernardine was honored with a 2006 Distinguished ED Service Award from CEP America.
Back to Top
