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St. Mary Changes the Patient Experience For Emergency Services
Split-Flow Model of Care aims to have patients seen by physician within 30 minutes of arrival

LANGHORNE, PA, (June 4, 2012) - In advance of the completion of the $22 million expansion and redesign of the Emergency Department and Trauma Center, St. Mary Medical Center already has changed the patient experience for emergency services. Originally planned to begin with the new department layout and construction, which is specifically designed to accommodate this innovative change, St. Mary Administrators and Physicians decided to expedite the implementation of the Split-Flow model of emergency care early to more effectively handle the current and increasing volume of patients who seek care at the St. Mary Emergency Department.

“We are not simply changing the room layouts or where people sit,” says Dr. Gary Zimmer, Chair of Emergency Medicine. “We are changing the entire organizational culture of our emergency-care processes in implementing a best-practice model of care delivery. It is all about getting the care patients need delivered to them in a more efficient and more effective timeframe. This is a big ‘win’ for residents in our area who use our emergency services.”

The Split-Flow Model is designed to parallel process triage and registration, have patients seen by a provider as quickly as possible, and to effectively manage patients based the severity of their conditions.

“Using the high efficiency structure of Split Flow, we can guarantee our patients will progress from the emergency department door to a healthcare provider in 30 minutes,” says Jeffrey Yarmel, St. Mary Executive Vice President and Chief Operations Officer. “That’s an impressive accomplishment for such a busy department.”

The Split-Flow model of care is an evidence-based best practice that hospitals nationwide are adopting with the goal of shortening the time before a patient is seen by a physician or care provider, as well as the overall length of time spent in an emergency department visit. Long-wait-times during an emergency department visit are a major reason for low patient satisfaction scores and increase the potential of a patient leaving before receiving medical care. The change to the Split-Flow model at St. Mary represents the ongoing commitment to performance improvement to provide the highest standards in quality patient-centered care.

“We aim to provide the best experience possible for patients who use our services,” says Charles Kunkle, RN MSN, Administrative Director of Emergency and Pediatrics. “Although the new construction layout will better accommodate the Split-Flow model of care, it made sense to retrofit the process to our existing space now to allow for the growth in the number of patients we are treating each month. Also, we feel we will be that much further ahead with this significant change in how we move patients through a visit to our emergency department when the expansion is completed early next year.” The Emergency Department at St. Mary currently is treating nearly 6,000 patients a month," Kunkle adds.

Using the Split-Flow Model of care, patients are first seen by a nurse immediately upon entering the Emergency Department. The experienced nurse who greets the patient upon arrival, use the guidelines of the Emergency Severity Index recommended by the Emergency Nurses Association to quickly determine the anticipated level of care needed by the person seeking treatment. An Emergency Department Pilot Technician then guides the patient to the appropriate treatment area to facilitate the care process. The intent is to redirect any wait time to be for results rather than waiting to be seen by a care provider.

The nurse who makes the initial evaluation will assign the patient to Pediatric, Prompt Care, Acute Care, or an Expedited Treatment Area (ETA). Prompt care is for minor injuries or conditions, such as a sprained ankle or flu; and acute care is for those with severe illness or conditions who are likely to be admitted to the hospital. Pediatrics, Prompt and Acute care are most familiar to people using emergency services and it is the commitment to getting them seen by a physician within a remarkably reduced time frame that distinguishes the new restructuring process in the Emergency Department.

The ETA is a resource-intense process in which evaluations, studies and tests are quickly done, and the patient moves to a comfortable environment to await results and treatment decisions. An emergency physician, registered nurse, and medical technician work as an integrated team to efficiently evaluate patients whose medical conditions require more information before a diagnosis and course of treatment can be decided.

Some patients may wait for the results of blood tests or x-rays while resting in recliner chairs. This “vertical” capacity saves space and keeps beds available for the sickest patients, and will remain part of the care model even after the expansion adds new physical space to the Emergency Department. The Split-Flow process calls for a tight coordination of support across many departments, including Imaging, Laboratory, Transport, and Environmental Services. The initiative to implement Split Flow required a significant investment in resources and the dedication of multidisciplinary departments working collaboratively to streamline processes and redefine schedules and roles.

The St. Mary Emergency Department and Trauma Center handle a wide range of illnesses and injuries with specialized medical teams prepared to respond immediately to traumas, strokes, and heart attacks. St. Mary provides around-the-clock access to advance brain, spine, orthopedic, and open-heart surgery; cardiovascular catheterization; digital X-ray; CAT scan; laboratory and other emergency services. The St. Mary Emergency Department and Trauma teams provide the advanced level of critical care offered in many metropolitan-area hospitals. In 2011, St. Mary treated nearly 69,000 patients in its current Emergency Department designed for a capacity of 50,000. While experiencing double-digit growth in the Emergency Department in each of past three years, patient satisfaction scores remain in the 90th to 95th percentile nationwide. The new expansion and redesign will provide the ability to care for up to 100,000 people annually – nearly double the current capacity – to help meet the increasing need in the region for prompt and advanced emergency care. St. Mary Medical Center is committed to delivering the highest quality patient-centered care using leading-edge technology and best-practice standards to serve the healthcare needs of our community.