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Good Shepherd leverages MEDHOST’s EDIS to achieve operational success and boost financial performance
MEDHOST EDIS supplied Good Shepherd with the tools to analyze processes and facilitate improvements.
Background: Good Shepherd Medical Center, based
in Longview, Texas, is a 412-bed hospital that houses one of the region’s only Level II Trauma Centers. In 2008, Good Shepherd received more than 89,000 ED visits and continues to experience a 7 to 10 percent increase in volume each year. Since more than 85 percent of Good Shepherd’s admissions come from the ED, the entire hospital’s success greatly depends on the operational efficiency of its ED.
Challenge: Good Shepherd’s paper charting process made it difficult for ED clinicians to know each patient’s location and status, so valuable time was often lost searching for this information. Without electronic data, evaluating charts and producing reports was complicated, and this limited the hospital’s ability to thoroughly review or adjust ED operations. Good Shepherd knew that inefficient processes would impede patient throughput, and with ED volumes on the rise, the administrative and physician leadership decided to evaluate technology solutions that would improve operations and deliver positive outcomes that would benefit the entire hospital and the patients it serves.
The Solution: Good Shepherd formed a team to conduct onsite demos of MEDHOST and other ED systems. It was important that each system be evaluated by its future end-users, so Good Shepherd included ED physicians, hospital directors, department leadership and nurse managers in the selection process. Ultimately, MEDHOST was chosen because of its ease of use, touch screen capabilities, graphical floor plan, robust reporting features, compatibility with the hospital’s MEDITECH MAGIC system, and customization capabilities.
One of the first changes Good Shepherd noticed after go-live was the abundant amount of data that was now available. MEDHOST’s reporting tools allowed ED managers to proactively identify bottlenecks and facilitate improvements. For example, reports showed which inpatient departments were slow to receive admitted patients, so ED leaders worked with administration and department heads to adjust processes, which minimized further delays. As a result, admission times decreased by 50 minutes, which created over 1,100 hours of additional ED bed time per month.
In addition to improving patient flow, MEDHOST’s reports helped Good Shepherd improve medication utilization, which changed the way the ED delivered care and generated positive financial benefits. For instance, since best practices indicate that Demerol is not the drug of choice for pain management due to the potential for dependency, side effects and adverse reactions, Good Shepherd’s ED physicians proactively leveraged MEDHOST’s reports to examine the amount and frequency of Demerol usage. Medication orders were then easily customized in MEDHOST’s Order Entry module. This led to a near elimination of Demerol orders in the ED, a significant clinical improvement. Good Shepherd also found that it could save $10,000 per year by administering the antibiotic, Levaquin, orally rather than through an IV. A simple modification to the Order Workups changed clinical practice so that patients received the same antibiotic with the same level of efficacy, in a safer, faster, and less invasive form.
Good Shepherd also leveraged MEDHOST to improve its ST segment elevation myocardial infarction (STEMI) management times so that STEMI patients receive faster primary percutaneous coronary intervention (PCI). Good Shepherd changed processes based on information they gleaned from reports and were able to reduce ED arrival to primary PCI time to 60 minutes, which is well below the American College of Cardiology’s STEMI guidelines of 90 minutes or less.
“Everything pre-MEDHOST was paper-based, so we had to sample the charts manually to look at turnaround times, which was very tedious and limiting,” said Ron Short, Good Shepherd Medical Center vice president. “With MEDHOST we have data that we didn’t have before, so we can review individual milestones, analyze core measures, proactively identify breakdowns, evaluate staffing patterns, and determine where we need to focus our process improvement efforts.”
MEDHOST’s
Patient Tracking module changed the way clinicians work in the ED and added new levels of efficiency and communication. ED clinicians can view each patient’s status in real time without having to search for charts. Large monitors display the ED’s floorplan and the status of each patient, and clinicians receive various real-time notifications when order results are available or other status changes occur. All ED staff are aware of the minute-to-minute status of the ED and can adjust their tasks accordingly. The benefits of the Patient Tracking module extend beyond the ED, as evidenced by their inpatient flow coordinator’s use of the ED floor plan to manage admissions.
“The Patient Tracking module not only helps to manage patient flow, but it also is one of the many features unique to MEDHOST. The availability of information, such as lab and radiology order status, delivered in a user-friendly, graphical way is a significant benefit to our staff. It has improved communication, satisfaction and quality of care,” said Short.
MEDHOST’s
ToolKit also contributed to Good Shepherd improving how it manages its patient load. By using ToolKit to customize the ED’s screening criteria, Good Shepherd now redirects more than 250 non-urgent patients per month to more appropriate and affordable community healthcare facilities. This process has created the space necessary for Good Shepherd to treat an additional 3,000 patients per year and avoid going on diversion.
“We have more than 89,000 patient visits each year and only 40 beds, so there’s no time for inefficiency. MEDHOST has transformed our ED in many ways, but the most significant change is the way that the system has revolutionized how we care for patients,” said Dr. John DiPasquale, co-director of the department of emergency medicine at Good Shepherd Medical Center. “I complete nearly 90 percent of my charts and orders at the bedside. I spend exponentially more time with my patients, which drives higher levels of customer satisfaction.”
With MEDHOST’s
Order Entry module, Good Shepherd physicians enter their own orders, which flow directly to ancillary departments such as lab or radiology. This comprehensive, integrated ordering process has not only improved patient safety, but it has eliminated additional steps for Good Shepherd’s staff. As a result, they have seen significant workflow improvements and decreased order turnaround time. For example, physicians are now able to see an average of 2.8 patients per hour.
MEDHOST has also transformed Good Shepherd’s ED into a profit center. Good Shepherd eliminated its traditional coding techniques, which left room for bias and delays due to the manual processes involved. With MEDHOST’s automatic, behind-the-scenes Charge Capture feature, charges are calculated as care is documented. And because documentation is more complete with MEDHOST, charges are no longer lost, and E&M Levels now accurately reflect the amount of care provided. As a result, the ED experienced a gross revenue increase of $100 per patient.
“MEDHOST truly delivers innovative and meaningful process improvements, and we are more successful since deploying their EDIS,” said Short. “The ease of capturing charges has made a significant difference in Good Shepherd’s bottom line, but more important, our patients are experiencing improved care.”
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