Muhlenberg Community Hospital ED Operational Assessment

Muhlenberg Community Hospital (MCH) in Greenville, KY took part in an Emergency Department (ED) Operational Assessment and Performance Improvement project as part of the Delta Rural Hospital Performance Improvement (RHPI) Program. Emergency Department Operational Assessments provide a comprehensive approach to assessing the patient flow and general ED operations. The goal of these assessments is to evaluate current ED functions, identify problem areas and issues impacting ED efficiency and recommends processes and solutions to resolve these issues.

The objective of a Performance Improvement project is to conduct rapid, focused analyses of the organization and its market that results in the identification of concrete opportunities for clinical service line, operational and financial performance improvement. Recommendations are focused to address short- and long-term issues with supporting action plans for implementation of immediate priorities.

In an interview with RHPI Project Staff Member, Rhonda Barcus, the CEO, CNO and E.D. Nursing Director of Muhlenberg Community Hospital, John Countzler, Kathy Mitchell, Matt Arnold, discussed the project's outcomes and future direction.

Q: What were the anticipated outcomes for this project?

A: There were two main anticipated outcomes for this project:

1. Utilization of agreed upon indicators for departmental utilization tracking and performance improvement measures for management and reporting purpose; and,
2. Improved patient satisfaction scores within benchmark of similar size hospital within 8-10 months.

Q: What were the actual outcomes of this project?

A: We created a dashboard of measures that gets reported up to the board of trustees (including volumes, transfers, throughput times, co-payment collections and the successful completion of follow-up phone calls). The ED volumes have been stable even with the loss of a few physicians and we are currently up to 55-57 patients per day. The charge capture also increased on average $200 - $250 per visit. In addition, we use Press Ganey for patient satisfaction surveys and scores have improved greatly. We were literally in the single digits at the beginning of the project and it has gone as high as 93.8% in the category of 'willing to recommend'. We have had the greatest improvement in patient satisfaction of the 19 hospitals in the vendor group!

Q: What are some other positive results from this project?

A: 

• There have been significant environmental changes that contribute to patient satisfaction and safety including an ongoing plan to maintain cleanliness.
• We have improved the charge capture in the ED. All of the recommendations have been put in place and now there is a significant change in appropriate revenue for ED patients.
• It was recommended that we do call-backs to ED patients. The original target was 65% for contact and we are exceeding that with the highest at 90%.
• There is a low turnover and a high retention rate of employees.
• Clinical quality measures are doing really well.
• We spent a lot of time figuring out who our patients are, where they come from and where they are going to (out-migration) for ED services. We have really 'upped the ante' and our ED is now the place to come to for the best treatment.

Q: What are your expected next steps towards adopting your consultants' recommendations?

A: There are a number of next steps that we will be taking including:

• Concentrating on driving growth and penetrating the market;
• Increasing our focus on quality metrics that are required by the Centers for Medicare and Medicaid Services (CMS) which are now being discussed in our weekly meetings;
• Implementing a small construction project which will lead to better safety around medication preparation; and,
• Continuing to focus on patient satisfaction surrounding family issues.

Q: Is there anything your hospital would do differently if you were able to repeat this experience?

A: We gained momentum with the weekly "Serious About Service" performance improvement team meetings that continue to identify and drive performance improvement.  We have been meeting now for over a year and wonder where we would be today if we had organized this group sooner, immediately following the completed assessment and developed an action plan.

Overall impact of the project

• Improved perception and pride in the community of the hospital
• Increased collaboration, improved ownership of departments to do what they can do
• Project brought leadership together to focus on what they can do rather than focusing on the individual departments
• Increased staff pride in the facility
• Ability to do a lot with a little bit of money because everyone did what they could to make improvements
• Improved staff satisfaction