Patient Safety, 2008

Ochsner Health Systems

August 2008

Ochsner Health Systems used the product of an AHRQ-funded Partnerships in Implementing Patient Safety (PIPS) grant to improve patient flow in the emergency department (ED) of its flagship hospital in New Orleans. The Ochsner Medical Center had been overwhelmed by rising patient volume after Hurricane Katrina.

Following Katrina, the number of patients who used the ED at Ochsner Medical Center rose by 60 to 70 percent—and on many days doubled. In part, this was due to the fact that, unlike other providers in New Orleans, the Ochsner hospital was relatively undamaged by the hurricane. Because of the rising number of patients visiting the Ochsner ED, wait times were high, the rate of patients who left without being seen by a physician spiked, and patient satisfaction scores plummeted.

Ochsner officials worked with Banner Health System, a Phoenix, Arizona-based multi-hospital system. With the support of the AHRQ PIPS grant, Banner pioneered an ED patient flow innovation in its (since closed) Mesa, Arizona, facility. The innovation was a change in process flow that Banner termed "Door to Doc" (D2D). It analyzed the resources, including both human and facility resources, needed in the ED at certain times to ensure that patients receive faster treatment. Banner Mesa was successful in reducing both the time for patients to be seen by a physician and the rate of patients who left without treatment, thereby improving patient safety.

Joe Guarisco, MD, FACEP, Chairman of the Department of Emergency Medicine and Chief of Emergency Services at Ochsner Health Systems, was helping Ochsner to change its method of patient flow management in the ED when he learned about D2D in February 2007. Guarisco was leading the adoption of a Rapid Medical Evaluation process flow, similar to Banner's split-flow model.

"Banner Mesa did the same things that we were doing, but they had a great deal more analysis and quantification of the problem," Guarisco says. Banner's D2D toolkit, which includes tools for implementation and addresses both the process and people aspects of process redesign, validated Ochsner's new workflow process.

With the D2D toolkit, patient flow is split into "less sick" and "sicker" patient subgroups. This determination is based on a brief look rather than a full triage. This has the advantage of keeping the vast majority of patients, the less sick ones, moving (rather than waiting in the lobby) during busy times. A key feature is that beds are reserved for sicker patients who truly need them. Less sick patients, who tend to be ambulatory, are not assigned to a bed; instead, they move among treatment areas as they would in a clinic setting. They remain dressed and vertical as much as possible, and they wait for their lab and other test results outside of the flow of other patients.

Using the AHRQ-funded toolkit, Ochsner refined its ED patient flow model, which it called "qTrack." The result: door-to-doctor times range from 22 to 32 minutes (down from 77); the left-without-treatment rate is down to 1.4 percent (down from 6.5 percent); and patient satisfaction, once in the 29th percentile nationally, is now in the 95th percentile.

"The number of patients who are coming to our ED is not going to go down, so we had to find a way to see more of them in the same space," Guarisco says. "The goal of the toolkit is to increase capacity without having to build a bigger ED, and we did that."

For more information on the Door to Doc program, visit: http://psnet.ahrq.gov/resource.aspx?resourceID=6689.

Impact Case Study Identifier: CQuIPS 08-05
AHRQ-Sponsored Activity: Partnerships in Implementing Patient Safety (PIPS)
Topic(s): Emergency Preparedness, Patient Safety
Scope: Louisiana

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Current as of September 2009

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Internet Citation:

Impact Case Studies and Knowledge Transfer Case Studies: Patient Safety, 2008. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/casestudies/ptsafety/ps2008.htm

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