Patient Safety, 2010

Fairview Southdale Hospital

January 2010

Fairview Southdale Hospital, a 329-bed nonprofit hospital in Edina, Minnesota, implemented AHRQ's Door-to-Doc patient safety toolkit after attending an AHRQ-sponsored training session in September 2008. This training was offered as part of an AHRQ Knowledge Transfer project. As a result of the training, the hospital emergency department (ED) experienced a decrease in the number of patients who leave without being seen and a decrease in the average length of stay.

In the Door-to-Doc toolkit, developed through AHRQ's Partnerships in Implementing Patient Safety program, patient flow is split into "less sick" and "sicker" patient subgroups. This determination is based on a brief analysis rather than a full triage. The system has the advantage of keeping the vast majority of patients—those who are less sick—moving during busy times, rather than waiting in the lobby or in the ED. The model was first pioneered as an ED patient flow innovation in Banner Health System's Mesa, Arizona, facility (since closed). It was a change in process flow that Banner termed "Door-to-Doc."

A key advantage of the Door-to-Doc model is that ED beds are reserved for sicker patients who truly need them. Less-sick patients, who tend to be ambulatory, are not assigned beds; instead, they move among treatment areas as they would in a clinic setting. These patients remain dressed and mobile as much as possible, and they wait for lab and other test results away from the flow of other patients.

Prior to attending the AHRQ-sponsored training, Fairview was experiencing decreases in market share, patient volume, and patient satisfaction scores. At the same time, its ED leadership was also searching for a new staffing model that would help increase efficiency. Fairview identified AHRQ's Door-to-Doc Toolkit as the model that would help the ED achieve this goal.

According to Heidi Meyers, RN, Nurse Manager, the Door-to-Doc toolkit has "reduced both length of stay and percentage of patients leaving without being seen. Within the first three months of implementation, the data indicated a significant shift downward for both metrics."

While the ED's left-without-being-seen rate averaged 3.14 percent for the first six months of 2009, the rate of patients who left without being seen has now decreased to 2.4 percent. In addition, the average length of stay in the ED has dropped from 215 minutes to 195 minutes following the implementation of Door-to-Doc.

In the three months after implementing Door-to-Doc, Fairview Southdale has also experienced improvements in patient flow. Patients are assessed immediately by a nurse at triage and transferred to a patient care room where other nurses can further monitor and assess them. Physicians are more accessible in the patient care areas to address patient needs and initiate interventions, providing more timely care to patients. According to Meyers, "While Fairview has not achieved full implementation of the Door-to-Doc toolkit, there is a significant improvement in patient safety and a reduction of risk for triage nurses, who previously monitored multiple patients waiting in the lobby in addition to new patients arriving."

Knowledge Transfer Case Study Identifier: KT-CQuIPS-28
AHRQ-Sponsored Activity: Partnerships in Implementing Patient Safety
Topic(s): Emergency Medicine
Scope: Minnesota

Improving Patient Flow in the Emergency Department. Agency for Healthcare Research and Quality, Rockville, MD. February 2008. http://psnet.ahrq.gov/resource.aspx?resourceID=6689.

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