ED Sign

“God laughs while men plan”

It is hard to believe we are well past one year in our new ED. By all measure we provided higher quality and more timely care than ever before. With 2012 winding down I thought I would recap the events of the year and some predictions on 2013.

The year in review:  (See graphs:2012 Registered,walkouts 2012,SJRMC SUMMARY)

  • 140,000 patient visits.
  • Though the rate of growth is slowing we will finish this year with 8% more visits than 2011.
  • Just as importantly walkout have reached an all time low.  In 2011 we averaged 2.2% weekly walkouts.
  • We will start 2013 with a 1.2% walkout rate.
  • The average patient spent 40 fewer minutes in our department (216 vs 256 minutes) this year.
  • Trauma alerts are up (about 30% to 1400 this year)
  • Cath lab times continue to improve (average DTB < 60 minutes).
  • The human side of our  department also grew.  Over 270  full and per diem employees now work in our department including 48 physicians.
  • We integrated fully into our new footprint and also said goodbye to our “temporary” home on the third floor when we opened our final component – the Senior ED (SrED).
  • We introduced new processes to improve care – SUPERTRACK (See SUPERTRACK: The Muda Killer Post) and…
  • Modified others to meet the needs of our patients – PreHospital Stroke Codes, Administrative Physician, Abbreviated Triage.

2013 and beyond:

  • I anticipate continued growth in our volume.  Assuming no local hospitals close we will probably see a 6%-ish growth next year (more if the flu season is bad)
  • Intra-departmental communication will be the single greatest area of concern.  We are too big both operationally and strategically for our traditional methods of communication.  Voalte is a good tool to improve operational communication. These posts help fill in some of the other gaps.
  • The concepts now in play in Supertrack\ACC4 will continue to be refined and the number of patients treated under this model (RAPID triage – UPRIGHT seating – TEAM tx approach) will expand.  My goal is a 100 minute TAT for ambulatory patients.
  • As pressures on space and patient satisfaction grow in the Pediatric department a Supertrack approach may be needed.
  • Excluding the regular Tsunamis of  BedHolds   (a Monday\ Tuesday phenomenon) we will have enough capacity to care for all who come in. Walkouts will begin to level off at a rate of < 1% per week.
  • Mostly what I see is tinkering with existing processes rather than new ones being introduced in the first half of the year.  
  • However, there will be an increased focus on critical patient processes related to streamlining  and standardizing the care of stroke, MI, and trauma patients.
  • We have some great educational opportunities coming up: the 5th annual EM symposium in April and also the 5th annual EMS Conference in January.

Making predictions is a cocky thing (see starting quote). The only thing I know for sure is that we will be a better department by the end of 2013 than when we started.

Hope everyone has a happy, fun and most importantly safe Holidays!

David