First in the State to Eliminate Practice of Ambulance Diversion
New Patient Rapid Assessment Ensures Timely Access to Provider Care
Kent Hospital President and CEO Sandra L. Coletta today announced major initiatives in its Emergency Department (ED) establishing it as the first and only hospital in the state to eliminate the practice of ambulance diversion, while also publicly unveiling a new rapid assessment model for patients coming to the hospital’s ED.
In order to make both programs safe, effective and patient centered, resources have been reallocated to support the new rapid assessment model. In addition, careful coordination, planning and patient flow throughout the hospital has been addressed from the moment a patient arrives to the time they are admitted or eventually discharged. More specifically this takes into consideration all elements that affect a patient during their stay – diagnostics, bed availabilities, scheduled procedures and more.
No Diversion at Kent
The practice of diversion is one that has allowed an emergency department to notify local emergency management services that, because of a high patient volume and strained staff resources, all ambulance traffic is to be redirected to another hospital if possible. This period of diversion would last for an amount of time sufficient to open beds and theoretically allow caregivers to treat and discharge or admit the current surge of emergency department patients.
This practice can also have challenging effects on not only patients but EMS personnel as diversion forces them to leave their immediate communities for an extended time and require them to seek mutual aid from another community EMS team. In the past, Kent Hospital had spent as much as 90 hours a month on diversion. In Massachusetts, state law prohibits the practice of diversion.
Patient Rapid Assessment
The patient rapid assessment model has dramatically reduced waiting time and in many instances it has been virtually eliminated. In the past, the average wait time to be seen when coming to the ED was two hours, while the entire patient visit averaged six hours. Today, with this new model of care, the average wait time is less than 45 minutes and the average overall patient visit is four hours while efforts are ongoing to not only maintain that but to continually improve.
This has been accomplished by establishing a more streamlined patient journey. A patient arrives at Kent and walks into the ED guest lobby and is greeted by a friendly patient advocate (a new role implemented in the new model) and escorted back into the treatment area to the intake booth.
From here a host of activities take place quickly including registration, bed assignment, nurse/provider interaction, lab work, x-rays, etc. Upon completion of testing a final determination is made on discharge or admission. If being discharged, the patient is given instructions, escorted to exit registration and given any necessary prescriptions. The rapid assessment model is currently in place from 9 a.m. through 9 p.m. every day. Expansion of these hours is anticipated later this year or early in 2012.
“We are very proud to publicly announce significant and important changes that we have internally been piloting for a number of months now,” said Coletta. “We have an obligation to our community to provide the best possible care, every day, all day.”
“Today these new measures create a more efficient and effective emergency department for our patients and our community partners in emergency care. I am deeply grateful to the staff of Kent Hospital and the entire emergency department team for the tremendous effort they are demonstrating as we move forward. Our doctors, nurses and so many others should be commended for their dedication and commitment to this major initiative,” said Coletta.
“The practice of diversion is not good for the quality of patient care as a whole,” said Michael Dacey, M.D., senior vice president and Kent’s chief medical officer. “Certainly patients could go elsewhere but when they do so there will be no immediate access to their current records or even the team of caregivers that already may have an established and well understood history of a specific patient. We are committed to providing the safest patient experience, combined with the highest quality of care that will result in the best possible outcomes.”
“I am very proud that today Kent Hospital is setting an important example in health care here in Rhode Island,” said Coletta. “I hope our experience will provide a roadmap for hospitals across the state to join in the no-diversion movement. I believe this should become the standard for care moving forward and am proud that Kent can help lead the way on this front.”
It should be noted that in the event of a natural disaster, internal disaster such as a significant facilities or equipment failure, or other community/statewide incident, patients may be brought elsewhere based on the overall impact of an event on the city of Warwick and the state as a whole.
Kent Hospital and The Michael J. Woods Institute is proud to partner with Ximedica and Brigham and Women’s Hospital of Boston on these important initiatives.
Ximedica’s Healthcare Delivery Solutions Division, a research and workflow design group headquartered in Providence, RI, began its partnership with Kent Hospital’s ED staff in 2010. The first charge was to deconstruct the complete patient journey of emergency department care starting from the time the patient walked through Kent’s door. In identifying the most risk prone elements of the system - breakdowns in communication, work-arounds, inconsistencies, and overall frustrations – the Ximedica and Kent team were able to collectively redesign improved workflow and communication processes that standardize, yet integrate the human component of delivering and receiving quality care.
“By engaging the front-line staff to have a direct hand in shaping their own destiny, acceptance to the proposed change and sustainability of the proposed change are enhanced exponentially,” said Kristin Simoens, Ximedica’s director of Healthcare Delivery Solutions.
Brigham and Women’s Hospital, as part of a larger clinical alliance that includes cardiology as well as emergency medicine, has had an active role in assisting Kent Hospital in physician recruitment and management, access, quality, safety and academic programs. Brigham and Women’s Hospital Department of Emergency Medicine has a long history of working with community hospitals to achieve excellence in the delivery of emergency care by using a patient centered, data driven approach to process redesign which focuses on quality, safety and the patient experience.
“Sandy Coletta, along with nursing and physician leaders, Rene Fischer and Dr. Michael Dacey, have been unequivocally committed to this remarkable process redesign and clearly view the delivery of high quality emergency care as their responsibility to the community,” said Richard D. Zane, MD, vice chair of Emergency Medicine at Brigham and Women’s Hospital.