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The Emergency Department at Methodist Medical Center of Oak Ridge has won a Level 5 award (the highest award attainable) for their improvements in clinical quality, operations and customer service at a national conference of the Institute for Healthcare Improvement (IHI) Collaborative in Atlanta.

In mid-November, Dr. Jim Henry, MMC medical director of the ED; Richard Hall, MMC emergency department manager; and Wilma Brantley, MMC chief nursing officer, presented MMC's results at the conference, held at the Ritz-Carlton Hotel. Methodist was participating with 19 other hospitals, and the only other hospital to score a level 5 was from Houston, TX.

The national honor was unexpected, Hall said, because MMC entered the collaborative three months late. In June, groundwork began for improvement of the ED' s clinical cycle time, and the actual implementation began in July.

"A Fastrack was designed…that's a way in which we move patients through the ED more efficiently. We reduced our 'door to doctor time' by direct placement of patients into available rooms, and using overflow capability and contingency planning," Hall said.

While the ED staff mapped out the most efficient patient flow patterns, triage protocols were fine-tuned, and an additional "Fastrack area" was set up during heaviest usage times. Hall said that getting "buy-in" from the ED physicians was instrumental in the improvement process.

"We added extra physician support and initiated ED physicians being on-call. In addition, when our ED physicians see patients in the department, they now distribute their business cards to improve communication and follow-up," he said.

Other factors involved in MMC's level 5 award include better coordination between ED medical services and the primary admitting medical service, improved communication between shift managers and the lab, and the use of clinical pathways.

"Clinical pathways are general guidelines which suggest a possible course of action for patients who exhibit signs and symptoms consistent with a specific syndrome or disease state. The clinical pathway document serves as an intervention record for the physician and nurse," Hall said.

Quarterly surveys conducted by the national Gallup polling organization show the ED's overall customer satisfaction is improving. Factors being studied include wait time, physician attitude and the customer's likelihood to return.

"Pride in the award should be shared not only with the ED team (staff, physicians, and management), but throughout the hospital's physicians and nursing. Support of the administration and ancillary departments was essential in attaining these benchmark goals," Hall said. "I also would thank Parkwest Hospital for their assistance in getting us involved in the collaborative. Dr. Henry and I were particularly inspired by Bert Toney, M.D. and Darrell Brackett, Parkwest ED director, who scored high with an IHI project last year."