The beginning of a journey — how UNM Hospital's CMO cut ER wait times in half
Under the leadership of CMO Irene Agostini, MD, University of New Mexico Hospital — the flagship hospital of UNM Health — reduced the time it took for a patient receiving care to get from the emergency room to a bed from 13.7 hours in March 2015 to 5.8 hours in October 2016.
Located in Albuquerque, UNMH is New Mexico's only Level I trauma center and manages more than 93,000 emergency visits annually. To address ER overflow, Dr. Agostini implemented patient flow technology solutions from TeleTracking in August 2014 to increase her team's patient care capacity. TeleTracking automates manual patient flow processes by digitally tracking patients and beds, thereby expediting patient throughput and enhancing efficient utilization of a hospital's facilities and equipment. According to UnitedHealth Care consortium data, UNM Health was the No. 11 most improved health system for patient throughput efficiency from fiscal year 2015 to fiscal year 2016.
In January, Dr. Agostini spoke with Becker's about leadership strategy and patient flow improvements at UNM Hospital.
Note: Responses have been lightly edited for length and clarity.
Question: Prior to the implementation of the patient flow technology, what challenges were impeding care at UNM Hospital?
Dr. Irene Agostini: We're literally the only Level I trauma center in the state. Before we implemented the patient flow technology, nobody really knew what was going on in the building. We were just putting fires every day. We would have to cancel elective surgeries and the emergency department was constantly in crisis. There was a sense of crisis throughout the hospital. Patients would have to be sent out of state or just not get care. Physicians were almost always angry because they couldn't take care of patients. In our building we run 95 percent or above for physical capacity for adult patients. If you include patients waiting in our ED and our transfer units, we run at more than 100 percent capacity every day.
Q: Under your leadership, patient wait times have dramatically decreased. How has this been achieved?
IA: Systematically we looked at everything using TeleTracking software. We looked at transport. We engaged all areas where improvements could be made, mostly in housekeeping and transport nursing. It sounds very straightforward but it's not. The housekeeping literally was working with faxes and phone calls. Now we know simple things like organized housekeeping can get beds open faster. Transporters now have iPhones, so they get jobs electronically. Every time there's a bed that is cleaned, we put a new patient in it as quickly as we can. We're very careful. Our ED had become so overcrowded it was an unsafe place for patients. Getting patients to beds quickly also improved patient safety.
Q: How did you get your staff to buy in to the new patient flow process?
IA: One of the things we did was make sure there was open communication. You can never communicate enough. There was also a lot of transparency about the process. We met with providers four days a week to help understanding around our reasons for making the change, bringing it back to we're not able to care for our patients and that has to change. In the past, each nursing unit owned their world and there were literally delays for hours and hours. We had to get people to understand what was happening in the rest of the hospital. When they're up on the floor they don't know about the 40 to 50 patients in the lobby. We have to keep the focus on the patient. That's still a daily thing in our culture.
Q: Of all the improvements made at UNMH during your tenure as CMO, which are you most proud of?
IA: I think this patient flow project and the cultural change it has facilitated are what I'm most proud of. Surgeons are now able to schedule elective surgery without a fear of canceling them. We've gone from a crazy reactive system to a proactive way of care, which supports physicians and indeed creates better care for patients.
We are far from achieving best practice, but this journey is only beginning. There's no resting on our laurels here.
Q: If you could sum your leadership strategy up in just a few words, what would they be?
IA: My leadership strategy is very straightforward. No nonsense, be fair, and be honest. If you're honest and tell the truth people will be willing to do what you ask. I do a lot of one-on-one communicating to get to know people. I've created an army of hundreds of physicians who know me. Getting to know people is crucial.
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