Tribal EM was hired to lead, manage and staff the emergency department at San Carlos Apache Health Care Corporation. Until that point, the emergency department (ED) was staffed predominately by a large staffing company.
Consequently, the ED metrics, quality of care, patient service and leadership suffered challenges similar to other IHS and 638 facilities that relied on large staffing companies for ED medical providers.
The San Carlos ED struggled with long waiting times, low morale, a revolving door of providers, and poor community perception mainly due to lack of trust and very high left-without-being-seen rates (greater than 30% in some months).
Tribal EM was engaged to bring the emergency department up to national standards, improve the quality of care and efficiency and decrease the staff and provider turnover.
These goals were all accomplished over the next year.
Tribal EM leadership immediately sought input from Tribal Elders, the Board and Community Members by simply asking for the expectations and ideal vision for the ED.
Next, Tribal EM engaged internal champions to formulate a 30-, 60- and 90-day action plan. Some initial “wins” helped to propel the team to make larger gains in the short term.
Tribal EM changed the staffing mix and hours to correspond to peak demand times, added point of care testing and implemented a discharge lounge, quick registration, and care paths.
Additionally, the use of scorecards was introduced and was used to compare shift versus shift, against national standards and against community needs.
The changes were not always easy but in the end, the Tribal EM team overcame each obstacle.
The culture shift in the San Carlos ED has improved the quality of care while improving quantitative metrics. Today, the ED surpasses national standards in door-to-provider time, door-to-decision time and left-without-being-seen.
Also, the number of transfers out of the facility has been cut in half through the use of clinical pathways and by increasing the acumen of the providers.
In addition, Tribal EM has low staff turnover and a team that enjoys a great relationship with ED nursing, ancillary and hospital leadership.
These changes were possible as a result of these projects led by the Tribal EM Leadership team which includes:
- Improving professional relations within the pre-hospital community.
- Achieving Base Station Status.
- Daily huddles with hospitalist group to lower risk of patient safety issues during admission “handoffs.”
- Adding Scribes to the ED.
- Lowered patient waiting times including: Door to Decision; Door to Doctor, Provider to Discharge and Provider to Triage.
- Promoting the use of clinical pathways in the ED.
- Redesigning the patient flow to a split flow system based on acuity.
- Seamless conversion to T-System charting (downtime charting) and Exit Care.
- Leading a number of hospital-wide quality initiatives.