Case Studies

Team Care Assessment Process Reduces ED Wait Times, Satisfies Patients

Mercy Medical Center - Roseburg

Hospital Beds 174
Annual ED Visits 46300
ED Beds 23
Fast FactLevel II Trauma Center

Team Care is a philosophy of collaborative care delivered at the bedside that has been used by hospitals across the country to improve emergency department (ED) throughput and disposition. Here we discuss Team Assessment, a process that streamlines intakes and gets visits off to a collaborative, patient focused start.

ED throughput had always been a strength for Mercy Medical Center, a 174-bed community hospital in Roseburg, Ore. As a result, Wade Fox, DO, ED Medical Director, and Sam Jones, RN, Director of Emergency Services, were far more focused on improving patient satisfaction and boosting productivity. Using ideas from a staff brainstorming session, they began building a new team-based intake process now known as Team Assessment.

Team Assessment brings the patient’s entire care team to the bedside during the first encounter to take a history and determine a plan of care. Each participant (provider, nurse, tech, scribe) carries out a predefined responsibility during the encounter. The process improves communication and patient flow from initial work-up through discharge.

To facilitate Team Assessment, two nurses and a technician are assigned to a pod of eight patients and work as a team alongside the physicians and PA/NPs. This arrangement allows for more flexibility than the traditional 4:1 nurse-to-bed ratio. Team members update one another on each patient’s progress via a wireless communications system. Emphasis on shared responsibility encourages everyone to pitch in where needed to keep the process moving.

After six months of Team Assessment, composite patient satisfaction scores and “likelihood to recommend” scores had soared from the first quartile to the third. Patients liked seeing teamwork on their behalf. They no longer needed to repeat their histories to multiple people, and because they were rarely left alone, their questions were quickly answered. What’s more, pain medications could now be ordered at intake, which improved pain management.

Another advantage of Team Assessment was greater job satisfaction and engagement, particularly among nurses. They reported improved communication and collegiality with providers and also liked how team-based patient assignments provided them with backup during difficult cases. “When there are more hands on the patient, we’re better able to help each other out,” Jones says.

Providers also benefit from increased teamwork. Dr. Fox says the nurses have become proactive in anticipating patient needs and gathering data for the physicians.

"When there are more hands on the patient, we're better able to help each other out."
Sam Jones, RN
Director of Emergency Services
Mercy Medical Center Roseburg

While throughput improvement wasn’t an explicit goal of Team Assessment, the department’s turnaround time to discharge (TAT-D) decreased by 20 percent after implementation — an improvement that has been sustained ever since. Dr. Fox says that while the drop was precipitated by a number of factors, efficiency gains due to Team Assessment almost certainly played a role.

Team Assessment was so successful at Mercy Roseburg that CEP America incorporated the process into its Team Care solution.

To learn more about Team Care, download our in-depth white paper.