UNC Health Nash Improves Emergency Department Experience

UNC Health Nash continues to trial new processes to improve the patient experience in the Emergency Department, where hospitals nationwide are struggling to keep up with demand. 

“Our Emergency Department has seen a 4% growth in visits year-over-year,” said Meredith Denton, director of Emergency Services at UNC Nash. “At the same time, we’ve been able to improve efficiencies and patient experience scores, thanks to creative thinking and enhanced collaboration among our medical staff, department staff and support services teams.” 

Last summer, the hospital announced a ‘nurse paramedic team model’ to allow the Emergency Department to care for more patients at a time, where paramedics handle critical tasks that complement and extend the abilities of nurses, allowing all clinical staff to work at the top of their scope and licensure.

This month, the department has been piloting a ‘vertical flow’ model aimed at expediting care at the front-end of the patient’s arrival.

“No one ever wants to be in an emergency department, and they certainly don’t want to wait long periods of time when they’re in pain,” said Denton.  “We are highly focused on moving our patients through their care process as safely and efficiently as possible, and are pleased we’re seeing positive results of these new models.”

Dr. Alex Warren, medical director of Emergency Services, explained the ‘vertical flow’ model is a way of evaluating patients at the front door based on their ailment, then routing them through the best pathway to manage their condition most quickly and effectively. 

"We have found that most of our ED patients, generally over 80% of each day's patients, are discharged from the emergency department and do not need to be admitted to the hospital,” said Warren. “To improve our efficiency in seeing as many patients as quickly as possible, the majority of our patients remain 'vertical' by being seen in a room, administered the needed testing or lab work, and then are moved back to the lobby where they can even receive IV fluids or other interventions while awaiting results. Once test results come back, patients are moved back into a care area where they can discuss their results and care plan with their provider.  This allows for us to maximize our resources for patients with more complex needs while providing more efficient and higher quality care to all of our patients." 

Denton reiterated that point by noting the improvement in patient experience scores and flow metrics the hospital measures on a daily basis.

“Since implementing these new processes, we’ve seen our ‘length of stay’ for Emergency Department discharged patients (those not being admitted to the hospital) reduce by 15%, down to just over three hours, which is significantly better than the national benchmark,” she said. “In addition, our patient experience scores now put us among the top 25% of emergency departments nationwide.”

Denton shared excerpts from a letter she received this week from a recent patient who was able to be treated quickly and with care and compassion:  “Thank you for the prompt, courteous service we received…  You guys were an amazing team… I appreciate your comfort, explaining what was happening and what the plan was.”