Since its opening earlier this year, St. Anthony Hospital in Gig Harbor has been using a “split-flow model” in the emergency department that’s designed to drastically decrease waiting time for incoming patients. According to officials with the Franciscan Health System, which owns the hospital, more than 85 percent of the patients arriving at the emergency department were seen by a doctor or physician assistant within 15 minutes, with an average wait of 10 minutes. That compares to an average of four hours in the waiting room in 2008 at hospitals nationwide, according to the American College of Emergency Physicians.
The St. Anthony Emergency Department doesn’t have the customary triage room. Instead, a patient who comes in will spend just a few minutes at the front desk, and is then taken to a room where staff determines how sick the patient is — either category 1, acute, or category 2, less sick. A physician and a nurse will then conduct the more detailed assessment together and determine the course of action.
This, according to St. Anthony emergency services director Dr. Paul Hildebrand, eliminates redundancy and delays. In a regular ER setting, the patient usually is assessed by multiple people, often having to answer the same questions each time. “Doing it together really enhances the team function, and there is less likelihood of missing something,” he said.
The split-flow model has resulted in high levels of patient satisfaction, said Kathy Bay, emergency department director at the hospital. “I’ve never worked in a department where I got as many thank-you cards every week,” she said.
One of those patients who wrote a thank-you recently is Diana Thompson. The Port Orchard resident had to visit the ER twice. While first time she was in a comma and doesn’t remember a lot, other that the doctors saved her life, the second time she remembers well.
“They were awesome,” she said. “They got me right into a room, there was no wait at all… I was pretty much cared for by a physician and an RN the entire time.”
She had such a good experience, she decided to send a thank-you note — and was surprised to get a response letter back.
The Emergency Department has 19 rooms that are designated for different purposes, but they are all flexible and any room can become an acute treatment space on the fly. Even in the trauma room, all the gear is portable and can be wheeled in and out quickly.
There is a separate entrance for ambulance deliveries, but patients arriving by ambulance don’t automatically get placed in acute care. And Bay emphasized there is no risk to the patients, no matter what category they’re classified into initially, because they can be quickly recategorized and all the rooms are equipped in the same way.
Those who are less sick and are ambulatory don’t have to be placed in a bed, and after being assessed and/or treated in the intake room, they wait for their lab results in a special waiting area —which frees up beds for new patients. The total length of stay for patients who are not admitted is about an hour shorter than at other Franciscan hospitals, which are not using this model.
Hildebrand said the less sick patients may be out of the hospital in two hours or less, which means if they left work to be evaluated, they can return to work on the same day.
“It’s a complete shift of the paradigm,” Bay said. “We have an experienced team, and you get used to things being done a certain way, so you have to re-teach.”
St. Anthony staff had the luxury of planning for this model well in advance, Hildebrand said. Staff trained months before doors opened, and they also staged practice drills. “We’re constantly reassessing what we can do differently,” Bay said. “It’s not a leadership model, it’s a department process — we talk about it as a group, and we’ve already made a few changes.”
St. Anthony is the only hospital in the state, and probably in the Northwest, using the split-flow model, Hildebrand said. Four St. Anthony leaders visited a Banner Health hospital in Mesa, Ariz. (Banner is one of the largest nonprofit hospital systems in the United States) to observe how the concept worked there. “We studied it and visualized how it may work here, and saw that it can be adapted,” Hildebrand said.
Banner Health implemented the model in 2006, calling it “door-to-doc,” and decreased waiting time by 58 percent and average length of stay in the ED by 14 percent, according to the Agency for Healthcare Research and Quality. Since then, Banner introduced this model in several of its nearly two dozen hospitals, and other hospital systems have adapted variations of the model. One of these most recent adoptees, Memorial Hermann Memorial City Medical Center in Houston, was able to cut its “door-to-doc” time from 93 minutes to 20.
Bay said using the split-flow model at St. Anthony doesn’t entail a higher than normal staffing number. “The difference is that we do the work at the same time,” she said. She acknowledges that the waiting time could change as the hospital gets more emergency patients, but says that’s why they’re looking at the data every day — and if the volume goes up over time, more staff can be brought in. The model was also proven to hold up at other hospitals as they got busier.
“We’re committed to the idea of the split flow because it’s best practice — and patient satisfaction scores tell us that,” she said.
