Performance Improvement for Rural Hospitals: Front Line-Driven Change to Decrease Transfer Time from ED to Inpatient Admission

Highlights: A recent performance improvement project undertaken by a Georgia Critical Access Hospital (CAH) demonstrates the potential for use of Plan-Do-Study-Act (PDSA) techniques to improve operations in the area of patient transfers from Emergency Department (ED) to Inpatient Ward. Implemented process improvement, including visual tracking of inpatient hold in the ED and bedside handoff led to reductions in admission decision to ED departure time and delayed or omitted ED admission orders.

Background: The Georgia Southern Flex Team, funded by the Georgia State Office of Rural Health, assists the state’s CAHs in pursuing financial and operational excellence. Under an ongoing grant, the team contracted with Mr. Eddie Perez-Ruberte, a highly experienced quality improvement professional, to provide a virtual course in PDSA methodology and to engage in one-on-one virtual consulting with interested hospital personnel on PDSA projects.

Project Description: Monroe County Hospital (MCH) is a 25-bed CAH with a nine-bed emergency department. During the first half of 2020, metrics on avoidable wait time indicated that MCH’s process of admitting patients from the ED needed improvement. Because of unaddressed areas of wait, the “admission decision to ED departure time” had been consistently longer than the organization’s goal for over six months. Given the limited bed availability in the ED (only nine beds), along with the negative patient experience associated with increased wait times, shortening the time from admission decision to ED departure was critical.