Case Studies

CEP America's Experience with Nurse-Physician Collaboration Improves ED Performance

Providence Holy Cross Medical Center

Hospital Beds 254
Annual ED Visits 72600
ED Beds 16
Fast FactWon the Magnet designation for excellence in nursing services

The emergency department at Providence Holy Cross Medical Center experienced a rapid rise in patient volume in 2007 to 2011, increasing by an additional 10,000 patient visits each year. With 250 to 300 patients per day, space in the 16 bed ED was quickly running out. Despite a newly constructed tower that facilitated quicker admission between the ED and inpatient side, space quickly ran out there too; and beds in the ED were increasingly being used for patients waiting to be admitted to the hospital. Patients faced long wait times at the front and back ends and the ED staff struggled to find room to deliver care.

ED Medical Director, Jason Fisher, MD and Director of Emergency Services, Missy Blackstock, RN, BSN decided they had to find a more timely and efficient way to care for their patients. Knowing the initiative would require hard work and accountability from all physicians and nurses, they drew upon CEP America’s experience in enhancing nurse-physician relations to foster better collaboration in their ED. Their first goal for the department would be to work together in bringing their time-to-provider (TTP) down.
Fisher and Blackstock began meeting weekly, sometimes more often, to define goals and manage the ED in a cohesive manner. Fisher also made himself more accessible to the nursing staff by attending their weekly meetings and asking the physicians to make sure they felt supported as they worked hard to meet the shared goal.
“The reason that we can provide such great care is because of our nursing staff,” says Assistant Medical Director, Alex Zlidenny, MD.

The ED pulled together to meet their TTP goal and quickly started focusing on improving other processes as well. To address their throughput issues, they began moving patients to a holding area, instead of keeping them in ED beds and decreasing turnaround time to admission (TAT-A).
“When you have a team, a big team, and everybody wants to shoot for the same goal, it makes it worthwhile,” says Missy Blackstock, RN, BSN. “We’re seeing great achievement with that.”

Providence-TAT-A-and-TTP.JPGAs a result of strong teamwork and ownership by ED physicians and nurses alike, the wait times at Providence Holy Cross Medical Center are now well under 32 minutes, even as the patient volume continues to grow. Improved metrics and collaboration has bolstered spirits in the ED and inspired them to tackle even greater goals.
“We’re very fortunate at Providence Holy Cross,” says CEO, Bernard Klein. “We have the CEP physicians combined with an excellent nursing staff in a culture of collaboration.”