When Baylor’s newest hospital in McKinney, TX, opened its doors, the Emergency Department (“E.D.”) volume was 40 percent higher than expected. This led to additional unbudgeted admittances to the med-surgical floor, which was not staffed to handle that load. There were only two hospitalists in the hospital. E.D. wait times became longer, as did hospital discharge times. Patient satisfaction was low. The leadership of the new hospital knew something had to change drastically.
The McKinney team implemented Service Care Bundle Training to address the issues. 500 staff members were trained. The training was conducted by leaders during staff meetings, and via recorded Webinars so different shifts could participate in the training. Staff were taught how to do the following:
- Round hourly on all patients.
- Conduct bedside shift reports with an emphasis on the sequence of activities that will happen next.
- Use AIDET (acknowledge, introduce, duration, explanation, thanks) to communicate with patients.
- Add components to the admitting process for learning patients’ preferences.
- Design a huddle protocol to review weekly patient satisfaction results.
- Design H.U.S.H. time (Help Us Speed Healing) processes from 9 p.m. to 6 a.m. to lower volume and promote resting.
- Structure Cuddle Time from 2 to 4 p.m. in the new family room; bring cookies and milk.
- Implement “Sacred 60” between 1 and 2 p.m. each day to round on families.
- Re-route traffic in the E.D. to maximize flow and communication with staff.
Results
- Inpatient satisfaction increased from 21 to 86 percent.
- Emergency wait times decreased from 18 hours to three hours.
- Employee retention was maintained at 97.4 percent.
- Emergency Department AMA rate was less than 1 percent.
- Core measure all-or-none bundle was at 97 percent.
- PCI door-to-balloon time was less than 67 minutes.
- VTE prophylaxis compliance was at 98 percent (best at Baylor).
- Length of stay was decreased by one day.
The use of short bursts of informal training at meetings and via recorded Webinars seems ideally suited to the hospital setting, because no one has time to sit down for formal training. The McKinney staff loved the just-in-time nature of the training, and they loved being trained by their leaders. Baylor is experimenting with this method at two other hospitals.
