Hugh Chatham Memorial Hospital, based in Elkin, N.C., is a private, not-for-profit hospital and has provided high quality medical care for residents over a distinguished 80-year history. The more than 800 employees of Hugh Chatham strive to uphold the hospital’s legacy and reputation as the area’s No. 1 choice for medical care, which is reflected by the higher than average growth of patient volumes in the hospital’s emergency department (ED).
Hugh Chatham leaders sought to upgrade its ED, both technologically and physically, so they looked to first implement an emergency department information system (EDIS) to transition off of paper charts and then build an entirely new ED that could better accommodate rising volumes and future growth. In addition, hospital leaders planned to convert the existing ED into a “Quick ED” for minor emergencies and illnesses to reduce congestion and wait times in the main ED.
Hospital executives outlined core objectives for the ED overhaul, which included decreasing turnaround times (TAT), improving patient satisfaction, ensuring integration and interoperability between its CPSI hospital information system (HIS) and the chosen EDIS, and growing its market share.
Hugh Chatham Memorial Hospital, based in Elkin, N.C., is a private, not-for-profit hospital and has provided high quality medical care for residents over a distinguished 80-year history. The more than 800 employees of Hugh Chatham strive to uphold the hospital’s legacy and reputation as the area’s No. 1 choice for medical care, which is reflected by the higher than average growth of patient volumes in the hospital’s emergency department (ED).
The Challenge
Hugh Chatham leaders sought to upgrade its ED, both technologically and physically, so they looked to first implement an emergency department information system (EDIS) to transition off of paper charts and then build an entirely new ED that could better accommodate rising volumes and future growth. In addition, hospital leaders planned to convert the existing ED into a “Quick ED” for minor emergencies and illnesses to reduce congestion and wait times in the main ED.
Hospital executives outlined core objectives for the ED overhaul, which included decreasing turnaround times (TAT), improving patient satisfaction, ensuring integration and interoperability between its CPSI hospital information system (HIS) and the chosen EDIS, and growing its market share.
The Solution
After reviewing several ED solutions, Hugh Chatham chose to work with MEDHOST because of the company’s broad integration and interoperability capabilities and because its EDIS is highly conducive to ED operations and workflow. MEDHOST was also attractive because of its proven track record integrating with inpatient hospital information systems and its commitment to making integration with their existing CPSI inpatient HIS a reality.
Implementation began immediately after the contract signing, with MEDHOST spearheading the project, managing all steps, and making recommendations to Hugh Chatham’s IT and clinical leadership to ensure a successful and timely go-live. In fact, the ED was fully live with MEDHOST EDIS in less than six months.
“In addition to assigning a dedicated team of resources to work on the implementation efforts, MEDHOST also provided us with an interface analyst who was instrumental in guiding and navigating the integration and communication with CPSI,” said Lee Powe, IS director at Hugh Chatham Memorial Hospital. “MEDHOST worked diligently to ensure that our interface with CPSI was fully operational, which had never been done before. Many visiting hospitals are still impressed to this day about what we’ve been able to accomplish with regards to integrating the MEDHOST EDIS with CPSI.”
By interfacing with CPSI, charts in MEDHOST EDIS are uploaded to CPSI after certain events occur, including when a patient is dispositioned and the chart is deemed complete. Also, orders placed with the EDIS’ computerized provider order entry (CPOE) flow directly to ancillary departments, which has streamlined workflow and communication. Once lab, radiology or other test results are ready, the information appears directly in MEDHOST EDIS, and alerts are sent to the patient’s clinicians so they can review results electronically. In addition, MEDHOST integrated its EDIS with Hugh Chatham’s Philips patient monitoring equipment so that the ED could automatically import vital signs into MEDHOST EDIS, removing redundant processes and further streamlining workflow.
Although Hugh Chatham’s ED experienced many workflow improvements after going live with MEDHOST EDIS, the ED continued to see above-average increases in patient volume. In fact, Hugh Chatham’s ED patient volumes increased by more than 76 percent in less than a decade as compared to the national average of 1 to 3.5 percent a year1. The new ED had more than twice the number of patient beds, and the existing ED space was transitioned into a “Quick ED” for non-acute care to alleviate strain on the main ED. Hugh Chatham ran MEDHOST EDIS in both areas, which ensured effective communication and patient tracking between units. The hospital also implemented MEDHOST ED Pass, a registration kiosk, so patients could check into either ED and identify their medical issue. This sped registration and enabled immediate screening for potential high-risk patients.
“We were really focused on patient satisfaction and turnaround times, two quality measures that were hard to improve without significant changes to ED operations. With MEDHOST EDIS and ED Pass in place, the improvement to turnaround time was significant, and our patient satisfaction scores increased into the 90th percentile,” said Lynn Kennedy, ED manager.
Dr. Stephen Isaacs, medical director of the ED, added, “The department operated more efficiently because every element of patient care, from check-in all the way through admission or discharge, was tracked within the MEDHOST EDIS. Wait times decreased so much that patients were in triage within 10 minutes of arriving, and with MEDHOST EDIS, our clinicians can spend more time at patients’ bedsides, which has been a key factor in our improved satisfaction scores.”
The improvements Hugh Chatham experienced are clear:
- Since 2008, Hugh Chatham’s ED census increased by more than 12 percent, yet the hospital has maintained an average turnaround time of three hours across all patients.
- Nearly 100 percent of ED patients who arrive on their own, i.e., not by ambulance, use ED Pass to register. This gives patients a faster way to communicate their needs to the ED clinicians; and likewise, ED clinicians gain a real-time view of the waiting room, including patient background and chief complaint before triage even occurs. Clinicians can now immediately see which patients need more immediate attention than others. ED Pass also provides more accurate demographics by importing information from the patient’s driver’s license, which is scanned at the kiosk.
- Patient satisfaction scores climbed to the 95th percentile in 2011.
Hugh Chatham also implemented the MEDHOST EDIS e-Prescribing module, giving ED clinicians an easy and secure way to electronically route prescriptions to each patient’s preferred pharmacy. More than half of Hugh Chatham’s ED prescriptions are already being processed electronically, which has cut down on paper, phone and fax prescription ordering and aligns with the hospital’s ongoing patient care, safety and satisfaction improvement initiatives.
“MEDHOST’s e-Prescribing module makes the prescription procurement process more convenient for our patients because more often than not, prescriptions are ready for pickup before patients even arrive at their pharmacy. Also, e-Prescribing has helped Hugh Chatham reduce the risk of medication errors associated with poor handwriting, illegible faxes and manual data entry. Overall, it’s a safer, more efficient process, and our patients absolutely love the convenience,” said Isaacs.
The implementation of MEDHOST EDIS has enabled Hugh Chatham to rapidly meet its improvement goals and proactively address its growing ED volumes. The hospital continues to hold regular meetings to track TAT and patient satisfaction, as well as determine how it can further leverage MEDHOST EDIS to make additional operational and care improvements. For example, Hugh Chatham leveraged the flexibility of MEDHOST EDIS to adjust practices and documentation templates to receive The Joint Commission’s Primary Stroke Center certification.
“Hugh Chatham’s ED has experienced many changes and significant growth, and because of the flexibility of the MEDHOST EDIS, the system has been able to grow with us and continue to meet our needs. Although MEDHOST EDIS is a departmental solution, it has had a system-wide impact, which is most clearly reflected by Hugh Chatham’s growing market share,” said Kennedy. “The best testament comes in the form of patient satisfaction surveys, and the vast majority of ED patients note their positive experience and desire to choose Hugh Chatham for their future care needs. The ED is often the front door of the hospital, and with MEDHOST EDIS in place, we can ensure that each patient’s experience is top-notch from the moment they arrive.”
