Bleeder to Feeder: How an ED Turned Its Business Around

Philip Betbeze, for HealthLeaders Media , March 11, 2011

The team also looked at occupancy challenges in its inpatient tower. Some were getting outpatient treatment, but using inpatient beds, he says. "We found a new space to meet those patients' needs and not interfere with occupancy."

By pulling reams of data, they noticed that a number of patients could be directly admitted to the hospital not through the ER but from a physicians' office.

Local physicians had complained about the ER being overcrowded, says Davis, whose team decided to create an express admission unit in daytime for physician offices. Today, the outside physician can call a hospitalist and then send the patient directly to the express admission unit, which unburdens floor nurses and gives patients a bed.

Finally, Davis and his team found a way to reduce the volume of non-emergent patients coming to the ED by opening—just last week—a QuickCare clinic on site that's staffed by a physician, a nurse practitioner, and a nurse, 11 hours a day and 12 hours over the weekend.

And he and his staff did it all without outside help. Not bad for a hospital CEO who 20 years ago was a physiologist in Jonesboro, AR. Davis explains his philosophy on solving problems internally when possible.

"I think we as administrators and operators sometimes fail to spend enough time getting to know the business, so we hire good consultants. But sometimes when they leave no one owns the solution," he says. "If we solve the problem, we all understand the issues and figure it out collectively, we never have to get reoriented. It's a process we all have grown through together."

This year, Charlton is seeing many more patients in the ED, and the all-important LWOBS rate is much decreased, although the true impact won't fully be known until the end of the fiscal year, Davis says. Having spent time as CEO at small hospitals in Arkansas, Kansas, and Texas before coming to Charlton, Davis says the ED is the perception-driver in every community in which he's worked.

"Our lesson here is we're not spending money on a facility when we can't improve the process within it," he says. "Operators today really have to understand the business from a grass roots level. Listen to your staff, your community and support it with data."

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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