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KDMC cuts emergency room wait times

King’s Daughters Medical Center has steadily implemented newtechnology and techniques throughout 2008 that have cut almost inhalf patients’ waiting time during visits to the emergencyroom.

KDMC Chief Nursing Officer Merlene Myrick said the emergencydepartment’s new gear has reduced patients’ LOS (length of stay)from 220 minutes, recorded during the first week of February, to118 minutes, record throughout June. The June average is twominutes under the department’s LOS goal of 120 minutes, and themost recent department best is 90 minutes.

“Decreasing the wait time for patients allows us to move morequickly to the next level of care,” Myrick said. “Once you improvein those areas, it facilitates the patients’ care throughout theED.”

Myrick said the reduction of the average LOS from 3.6 hours tojust under two hours is the end result of an ED-wide performanceimprovement project undertaken in April. That’s when the ED movedout of its old quarters into the temporary modules in anticipationof the completion of the hospital’s new ED.

The project’s biggest impact has been the installation of anelectronic medical records networking system produced by T-System,Inc., of Texas. The T-System includes mobile laptop computers onrolling stations that allow for medical information to be recordedquickly from anywhere in the ED, and small tablet computers withtouch screens – like oversized personal digital assistants – thatreceive the information wirelessly.

The system also includes a 42-inch LCD (liquid crystal display)screen that allows physicians and nurses to make quick assessmentsof patients’ information.

Basically, the T-System allows ED personnel to spend less timewith charts and clipboards and more time with patients.

“They can carry the tablet in one arm, check off the orders withthe stylus and see the patient’s information right there,” saidKDMC Information Systems Manager Carl Smith. “It’s bedsidecomputing.”

Smith said the hospital is slowly phasing out the old method ofwhiteboards, clipboards and the notorious handwriting of doctors.The T-System’s computers and displays are interfaced with thehospital’s main system, Meditech, and medical information enteredanywhere flows instantly to all the components.

T-System, Inc. spokesman Bret Coons said the custom-builtT-System is currently installed in 42 percent of the nation’shospitals, and in 1,600 medical facilities worldwide.

KDMC plans to add more components to the T-System when the newED is completed in spring 2009.

To accompany the emergency department’s new electronics, KDMChas also made a few human adjustments to further drive down the ERwait times.

KDMC Emergency Medical Services Director Terry Singleton saidthe hospital has hired a “flow coordinator” who helps managetraffic in and out of the ER during peak hours and helpsphysicians, nurses and technicians communicate. The hospital useslicensed practical nurses as its coordinators.

“It’s something unique to our ED,” Singleton said. “Other EDshave clerks, but we wanted someone a little more medically trained,so we made it a licensed position.”

Singleton said KDMC has also shifted some nurse practitioner andtechnician schedules from a 9 a.m. to 9 p.m. slot to 11 a.m. to 11p.m. to fit ER peak times. Some technicians also serve astransporters, taking patients to their rooms.

“We monitor a lot of numbers in the ED, but the main goal is thetotal LOS,” Singleton said. “If you decrease the LOS for everybody,the ER doesn’t get backed up and have people in the waiting room.How important would it be for you to get immediate care? That’s howimportant it is to us.”

Singleton said the ER sees an average of 60 patients each day -a 15 percent increase in volume since last year that is possibly aresult of Brookhaven’s lack of family care physicians.

The hospital last month enacted a screening plan that requirespatients seeking care in the ER who have non-emergency conditionsto make a $200 deposit or applicable co-pay or a deferral to thehospital’s Quick Care Clinic. The screening is designed to decreasethe amount of non-emergency traffic in the ER and reserve thedepartment’s high-powered medical equipment for more severeconditions, Singleton said.