Benchmarking the Emergency

Mark Reiter MD MBA FAAEM
St. Luke’s Hospital Bethlehem, PA

Objective • To introduce the concept of benchmarking as a tool to improve emergency department performance • To identify benchmarking metrics relevant to emergency medicine .

Disclosure Dedicated to Emergency Medicine performance excellence through benchmarking and process improvement .

Robert Camp PhD brought benchmarking to Xerox in 1981 ASQC Quality Press. 1989 .

Robert Camp PhD • “Benchmarking is a proactive process to change operations in a structured fashion to achieve superior performance.” • “The benefits of using benchmarking are that functions are forced to investigate industry best practices and incorporate those practices into operations.” .

external benchmarking • Needed to effectively evaluate success of process improvement .Benchmarking • Process of measuring and comparing performance • Identify and incorporate best practices • Goal is to improve performance • Internal vs.

Cobb (Digital Electronic Corp) From Quality to Business Excellence American Society for Quality © 2003 .” Charles G.“Metrics without goals are just interesting data.

Gas Station Analogy • When low on gasoline many turn into the station with the lowest price • In doing so. many assumptions are made relating to presumed sameness – Gallon accurately measured – Comparable octane – Equipment working .

e. pediatric ED) Welch S. Augustine J. MD contact time. 2006 Oct. active acuity level (ESI). daily boarding hours) • Space definitions (i. decision to admit time. Reese C.e. Camargo CA Jr. Emergency department performance measures and benchmarking summit.ED Performance Measures and Benchmarking Summit • 19 individuals representing different EM groups met in Atlanta. Epub 2006 Aug 31 . arrival time. GA in February 2006 • Goal of summit was to establish consensus regarding benchmarking terminology • Time definitions (i. ED. Academic Emergency Medicine.13(10):1074-1080. left ED time) • Time interval definitions (door-to-doctor TAT.e. laboratory TAT) • Process definitions (i.

Benchmarks – Turnaround Times Flow Tests • Door-to-Triage Door-to-ECG • Door-to-Doctor Order-to-Blood Collected • Door-to-Discharge Decision Order-to-Urine Collected • Door-to-Admit Decision Order-to-X-Ray/CT • Discharge Decision-to-Depart Order-to-Lab • Admit Decision-to-Depart Time-to-Read Result CT/US .

Gap = 5 min .

Where Are Your Bottlenecks? •Reception •Triage •Registration •Nurse evaluation •Physician evaluation •Testing •Treatment •Consultation •Disposition •Leaving the ED .

e.Crowding measures (i. pts per hour. decontamination protocol) .Benchmarks in Emergency Medicine .Staff satisfaction measures (i.e. hallway use) . patient callbacks) . LWBS. time to PCI) . job satisfaction.e.e.Staffing measures (i. early goal directed therapy for sepsis.e. attrition) . bedside registration. therapeutic hypothermia) .Patient satisfaction measures (i.Clinical “best practices” (i. satisfaction survey results. midlevel supervision) .ED operations “best practices” (i.e.Outcomes measures (ASA on arrival.

3% excellent .9997% – negligible at 6 SD (some per million) – impractical for most ED benchmarks • Example: LWBS – 2 sigma= 15% poor – 3 sigma = 3 % average – 4 sigma = 0.Six Sigma Overview • Developed by Motorola • Experts called “Black Belts” • Based upon no “defect” in 99.

6 Sigma Concept of “Defects” • “Defect” means outside tolerance limits • Time to triage – > 15 minutes Defect – < 10 minutes Average – < 5 minutes Goal • “Defect opportunity” is the chance for a defect to occur – Reviewing outlier cases offers insight into process improvement – Common in EM management .

customer needs Measure baseline.6 Sigma Process Improvement: RDMAIC • • • • • Recognize an opportunity Define via process maps. cause. policy development . trends – process maps Analyze problem. and measuring benefits • Control … ‘stay in control’ – maintain gains and seek new opportunities – training. collect data Improve by developing solutions. implementing a change plan.

Lab Test Example Flow Mapping • Reconstruct all steps of process • Find redundancy – “waste” • Estimate TATs • Seek to improve any part of the process .

The TQM Culture • • • • Quest to improve results Driven by customer needs/expectations Meets needs of all stakeholders Transition from reactive to proactive problem solving • How? – – – – Benchmark Survey Engage all stakeholders / Hospital-wide impetus Reward/Recognize successes .

Questions? .