With goals of getting the right processes and staffing in place, the administration and staff at LewisGale Medical Center in Salem, Virginia put a priority on patient-centered process improvements that would shorten wait times and length of stay in the emergency department (E.D.). Here’s how they improved metrics including decreasing the ED ALOS by 45 percent.

1. “The group effort of the emergency department leadership, nurses, staff and
physicians was outstanding. The work accomplished here will ensure these new
practices are more efficient, easier for our teams and positive for our patients.
From day one with the new process, the metrics clearly indicate the determination
of this team to deliver quality care. It’s working and it’s fascinating.”
Kim Mecom, MSN, RN, CEN
Director of Emergency Services
FIND OUT MORE TODAY!
www.emcare.com
Call: 877.416.8079
A NEW E.D. PROCESS AT LEWISGALE RESULTS
IN BETTER PATIENT-CENTERED METRICS
Case Study: LewisGale Medical Center (“LewisGale Main”), HCA Virginia
Salem, Virginia
Over 45,000 Annual E.D. Visits
Challenge. With goals of getting the right processes and staffing in place, the
hospital’s administration and staff put a priority on patient-centered process improvements
that would shorten wait times and length of stay in the emergency department (E.D.).
Solution. Through operational assessments and facilitation of the lean-based “table
top simulation,” areas of waste such as wait times, delays and redundancies often become more
evident. A table top simulation exercise was facilitated by EmCare, providing an opportunity for
informal discussion of processes and roles and ultimately revealing needed improvements from the
patient’s perspective. With one goal in mind, providing better care for patients, the hospital formed
a committee to synthesize ideas on how to address the challenges and make improvements. The
committee deployed a number of creative and highly effective tactics including:
• Assigning red, blue, yellow and green zones, each with its own “results pending” area
• Designating a “flow master” as a new role for the Charge Nurse to ensure that labs, imaging
studies, IVs and medications are completed in timely fashion
• Re-evaluating the rapid treatment area – no more patients in the lobby
• Developing a “saturation” and “surge” plan
• Proper utilization of the sub-waiting room staffed by an advanced practitioner to keep
beds free, moving non-acute patients through the process more quickly and reducing E.D.
length of stay
Results. The commitment of the staff and leadership was the key to success. Their dedication
led to positive changes for patients and metric improvement goals. In collaboration with EmCare,
the committee worked with nurse leaders and staff to generate vast improvements. By the second
day of the exercise, the department decreased the ED ALOS by 45 percent.
A comparison of two similar days with very different results:
© 08/2014 ® EmCare, Inc. − All rights reserved.
Emergency Department Average Length of Stay
(ED ALOS) decreased from 229 minutes to 141
minutes, a reduction of 88 minutes.
Zero patients left against medical advice (AMA)
(In the month prior to process changes, the
hospital had 47 AMAs.)
To learn more about the resources and tools that can help your hospital improve metrics and
patient care, contact EmCare at 877.416.8079 or visit us at www.EmCare.com.
0
50
100
150
200
250
300
LOS Admitted LOS Released LOS Low
Acuity
ALOS
259
212
166
229
165
137
83
141
Jan
Mar