Rounding in the ED What Goes Around Comes Around Beaver ...studergroupmedia.com/WRIHC/presentations/rounding_in_the_ed_wha… · • Patient Rounding is ... patient satisfaction surveys,

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Rounding in the Emergency DepartmentWhat goes aROUND comes aROUND:

Excellence Starts with You!Jamie E. Hendrix, RN, BSN

Director of Emergency Services Beaver Dam Community Hospitals, INC. (Beaver Dam, WI)

Richard Tovar, MD, FACEP, DBAMT Infinity Health Care Medical Director

Beaver Dam Community Hospitals, INC. (Beaver Dam, WI)

What’s Right in Health CareSM | Evidence to Outcomes

Presentation Objectives

1. Participants will learn how they can leverage themselves and their teams to achieve customer service excellence.

2. Participants will learn the essential steps to take in transforming their department and to get desired results.

3. Participants will learn how implementing essential tactics such as patient and staff rounding will help them to achieve desired results in customer and staff satisfaction.

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Beaver Dam Community Hospitals, INC.

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Beaver Dam Community Hospitals, INC.

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It’s Not About Us, It’s About the Patients.

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Our Charge:

Overhaul the ER.

Conduct an image campaign.

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How Do You Start?

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Beaver Dam Community Hospitals, INC. Emergency Services Department Vision

The ED will be a “Center of Excellence” for urgent and emergent care.

High Quality Clinical Care

Prompt and High Quality Service

Personalized Care

Non-judgmental

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It Starts with You

What goes aROUND comes aROUND.

What does this mean anyway?

– To make a complete change or reform.

– (idiomatic) To complete a cycle of transition, returning to the point of origin.

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It Starts with You

Ask yourself:

Do I make customer service my first priority?

Do I role model what I expect of others?

How would I like to work for me?

What kind of leader am I?

Am I a “winner or a whiner”?

Am I an owner or a renter?

It begins with self reflection!!

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Making the Vision Reality

Staff Ownership/Accountability• Accepting the past and looking to the future.

• Owning your part of the past.

• Accept don’t defend.

• Being willing to change.

• Asking yourself, “Have I been more in to me than the patients/customers”?

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It’s Not About You, It’s About the Patient . . .

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TransparencyBe open and honest about current state, assessments, expectations, and actions needed for improvement.

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Perception is Reality . . .Is the lady pictured old or young?

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Don’t be too Quick to Judge Others . .

Your assessment may be way off!

Your assessment may be way off!

Click here to play video clip

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Moving Forward

• Complete the past and move forward.

• If you keep one foot in the past and one in the future you will never move forward.

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Shared Vision & Goals

• Goals related to Customer Satisfaction, Turnaround Times, and Volumes established.

• It is not about us, it is about the patients. Patients are the center of all we do, it because of our patients that we are employed.

Clear Expectations• Patient Rounding is

required every 30 minutes

• Technical/Clinical Skills

• Customer Service Skills

• Teamwork/Communication

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Teamwork

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Essential Components of Management Team:

• Shared goals

• Collaboration

• Partnership

• Trust

• Respect

• Support

• Open Communication

• Managing up

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You can do anything with the right amount of TEAMWORK!

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Teamwork• Teamwork established with other

departments• Partnership with Medical Staff• By working together and focusing on

the patients not ourselves, we created a pull verses a push effect.

• Behavioral standards established and enforced.

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Making the Vision a Reality

Teamwork• We clearly defined the 3 aspects we were

looking for in each team member.

Clinical /Technical Teamwork/Communication Customer Service

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Make sure you have the right people on your team.

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BDCH ES Team Members

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BDCH ES Team Members

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Accountability

• Hold staff accountable for expectations related to care, service, teamwork and communication.

• Use feedback from customer concerns, patient satisfaction surveys, and clinical documentation including timelines.

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Accepting Change

• If you want to get what you have always gotten, then keep on doing what you have always done.

• You can’t control what happens to you.

• You can however, control your response or attitude toward what happens to you.

• When you control your response, then you will be mastering change verses letting it master you.

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Changing the Way We Do Things . . .

TraditionJust because we have been doing things this way

for years, doesn’t mean it makes sense.

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The best way to know how you are doing, and what needs to improve . . .

Measure, Measure,

Measure!!!

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Measurement

• We measured and analyzed the following feedback on a monthly basis. All information gathered was used to make and evaluate process changes.

- Customer satisfaction ratings*Individual provider*Shift*Department

- Direct customer feedback- Turnaround times/metrics - Volumes

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Change- It Starts With YOU

• “Leaders establish the vision for the future and set the strategy for getting there; they cause change. They motivate and inspire others to go in the right direction and they along with everyone else, sacrifice to get there.” –John Kotter

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Leading Change

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Thoughts on Change:

You can change anything if you do following:

1. You clearly decide what it is that you're absolutely committed to achieving

2. You are willing to take massive action

3. You notice what is working and what is not.

4. You continue to change your approach until you achieve whatever life gives you along the way. - Anthony Robbins

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Communication

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Communication

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Communication

• Share the results of your efforts with members of the team.

-consistency

-transparently

-acknowledge positive

-change processes as needed

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Rounding

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Rounding—Physician style

• Rounding is performed on patients for 3 reasons:

– Customer service/guest relations

– Quality improvement

– Enhanced reimbursement

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• Physician Electronic Medical Record (EMR)– Order entry/chart documentation

• Requires a minimum of 3 separate rounding times with the patient/family– Initial contact– Update on ED throughput– Discharge

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Initial contact:

• Patient is greeted by the physician/physician extender

• Initial exam performed

• Diagnostic and treatment plan explained

• Emphasis on estimated waiting time for throughput presented if possible

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Update:

• Any delay in diagnostic tests, consultations, etc., given as update to patient AND family

• Partial results shared with patient and family

• Reassessment of throughput time

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Snap shot of EMR serial exam documentation:

• Repeat exam time snap shot

• Serial exam for abdominal pain snap shot

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ED Observation




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Serial Exams



Discharge:

• Summary of diagnostics/treatment

• Estimated time to discharge or admission

• Always ask “any other questions or concerns??” at the termination of visit

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47

ED Course



• Feedback to all physicians and physician extenders on a monthly basis

• Positive and negative customer service and quality benchmarks are shared with each provider on an ongoing basis

• Several physicians have increased their guest relation scores with feedback

• With positive results, renters become owners

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Rounding-Physician Style

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Press Ganey Rounding Scores

20

74

82

16

69

81

15

75

83

17

74

82

0

10

20

30

40

50

60

70

80

90

2006 - 2007 1st 6 months of rounding 1st Quarter 2008

Doctors courtesyDoctor took Time to ListenDoctor informative Re: treatmentDoctors concern for comfort


Average Turn Around Times for MD

12.75

66.25

53.5

0

10

20

30

40

50

60

70

Provider "X"

Min

utes

In Bed / Initial Contact Initial Contact / Care Complete In Bed / Care Complete


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Rounding-Nurse style

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Rounding-Nurse Style

What is nurse rounding?

• Nurses spend more time at bedside.

• Patient knows who the nurse is.

• Questions are answered.

• Patient and family informed of delays.

• Comfort needs are met.

• Rounding is documented.

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• Each patient is seen by the nursing staff every at least 30 minutes.

• Nursing staff use the AIDET format when rounding.

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AIDET

A- Acknowledge

• Address patient by name. • Make the patient feel welcome and as

though you expected them.• Use eye contact.• Use welcoming and positive body

language.

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AIDET

I- Introduce

• Tell the patient your name, title, and credentials.

• As you get more comfortable with rounding, share more information such as:–Skills, experience, certifications–Manage up coworkers and other

departments

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AIDET

D- Duration

• How long is the expected wait?• How long will test, or procedure take?• How long will results take? • When will the doctor or next caregiver

come in?

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AIDET

E- Explain

• Tests/procedures

• Discharge and medication instructions

• What you are doing, why, and what your thought processes are

• Answer questions

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AIDET

T- Thank

Remember that HealthCare is consumer driven. Patients have choice and they have chosen to come to your hospital. Thank them for choosing you.

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Rounding

How to start:

• Provide facts about current state.

• Make expectations clear.-every patient-every day-every time

• Find a way to measure results.

• Follow up on noncompliance.

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Nurse Rounding Results

Press Ganey Rounding Scores By Percentile Ranking

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83 83

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8590

55

8287

54

8693

0

10

20

30

40

50

60

70

80

90

100

2006 - 2007 1st 6 months of rounding 1st Quarter 2008

Nurse took time to Listen

Nurses attention to your needsNurses informative re treatment

Informed about delays

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BDCH Outcomes

CommunityGrowthPerformancePeopleQualityStakeholder Satisfaction

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Stakeholder SatisfactionEmergency Room Press Ganey Overall Percentile Scores

0

10

20

30

40

50

60

70

80

90

100

2006 July 2, 2007 -Dec 31,2007

4th Quarter2007

1st Quarter2008

Standard OverallStandard NursesStandard MD's

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Stakeholder Satisfaction

Patient Satisfaction by Volume

83.7

88.5

81

82

83

84

85

86

87

88

89

National AverageBDCH Average

National Average for ED's with 20,000 - 29,999 visits per year

BDCH ER AND UC with 24,261 visits

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Stakeholder Satisfaction

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Beaver Dam Community Hospital, Inc. Press Ganey - Emergency Services 2006 - 2008

73.178.680.9 81.7

85.786.483

8885

0

10

20

30

40

50

60

70

80

90

100

Overall Facility Rating Overall Rating of Care Likelihood of Recommending

Perc

entil

e R

anki

ng

20062007Jan1 - June 2008


People

• New ER Physician Group hired.

• ER RN Vacancy Rate reduced from 33.03% in 2007 to current rate of 3.13 YTD%.

• Charge Nurse and Tech. positions added for evening and weekend (high volume) hours.

• Clinical Nurse Manager hired to increase the skill level of nursing staff.

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Performance

Average Turn Around Times Arrival to Discharge Emergency Department

141136

131135

40

60

80

100

120

140

160

June 2006-June 2007 July 2, 2007- Dec. 31,2007

4th Quarter 07 1st Quarter 2008

June 2006-June 2007July 2, 2007- Dec. 31, 20074th Quarter 07 1st Quarter 2008

GOAL-120

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Performance

Beaver Dam Community Hospital Med Flight Ground Times

24 24

64

1917

32

0

10

20

30

40

50

60

70

Regional ER to Med Flight Call Med Flight Ground Time Med Flight Call to Arrival at UWHC

20062007

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Performance

Average Time Spent in US Emergency DepartmentsArrival to Discharge 2007-2008

Nat. Average TAT

Wisconsin Average TAT

BDCH Average TAT

0

50

100

150

200

250

300

National average TAT 240Wisconsin average TAT 182BDCH average TAT 130

In Minutes

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Growth

Number of Emergency Services Visits

22405

24261

13487

8918

15002

9259

0

5000

10000

15000

20000

25000

30000

Urgent Care Emergency Department Accumulative

2006

2007

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Excellence Starts With You!

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What’s Right in Health CareSM | Evidence to OutcomesEmergency Services72



Conclusion

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Thank You!

Jamie E. Hendrix, RN, BSNDirector of Emergency Services


Richard Tovar, MD, FACEP, DBAMT Infinity Health Care Medical Director


Documents

Rounding in the ED What Goes Around Comes Around Beaver ...studergroupmedia.com/WRIHC/presentations/rounding_in_the_ed_wha… · • Patient Rounding is ... patient satisfaction surveys,