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Improving Care in the NVRH Emergency Department

March 31, 2009

In the fall of 2007, Northeastern Vermont Regional Hospital’s Emergency Department joined the Institute for Healthcare Improvement (IHI) project titled Operational and Clinical Improvement in the Emergency Department. Teams from a wide variety of health care organizations around the nation work together to test and implement meaningful and sustainable changes in specific areas. During this two year quality improvement program, participating hospitals collaborate, brainstorm, communicate and test ideas to improve patient flow from the time they arrive at the hospital, to the time the patient is either discharged home, transferred to a tertiary care facility or admitted for further care.

The IHI approach to improving operational and clinical outcomes in the emergency department focuses on optimizing the patient’s entire emergency department experience. Emergency Services brought together a team of physicians, management and staff from nursing, admitting, diagnostic imaging and laboratory. "The ED is frequently the first contact patients have with the hospital. Each patient’s perception of care received during their visit sets the tone for future visits to the hospital," said Deb Bach, Director of Emergency Services at NVRH. It is essential that the care received in the Emergency Department is safe and effective.
Upon close self-assessment, re-evaluation of procedures, guidance from the IHI faculty and collaboration with other hospitals in the IHI Learning Community, the ED set their overall project goal to lower patients’ length of stay (from the time they walk in the door to the time they’re either discharged, admitted or transferred) by 25% by the fall of 2009. Perceived bottlenecks were examined closely and the team set out to make improvements by establishing new processes. These improvements include implementing a standardized five level triage system to help increase flow through the department while providing the appropriate level of care to all patients. The team also implemented point of service testing for certain lab results to provide the physician with information to help streamline medical decisions. Working closely with other departments in the facility, the team developed and implemented a patient hand-off document entitled the "Ticket-To-Ride". This document travels with the patient when leaving the ED for tests performed in another area of the hospital, and provides information to staff regarding key issues to be aware of during the time patients are in diagnostic imaging.
These are only some of the changes implemented, but the results have been very positive. "Participating in the IHI program has given the team the opportunity to make key changes resulting in increased patient flow and a decrease in our overall length of stay for patients. Any kind of program requiring this level of self assessment is challenging for everyone involved, however, active participation from the staff has been effective as well as rewarding. The success of the project can be measured not only with the decrease in length of stay, but also by the increased teamwork. All of the departments are pulling together in the same direction to provide better care for our patients," states Bach.
NVRH has previously participated in three one-year projects with the IHI IMPACT network: Improving Surgical Care, Transforming Medical Surgical Care, and Improving Perinatal Care. "All the programs we’ve participated in have demanded self-assessment and provided us with tools to implement new ideas and create improved outcomes that are exciting and sustainable," said Colleen Sinon, Vice President of Quality Management Programs at NVRH. "The collaboration and communication with peers across the country is very helpful. Ultimately, it’s about creating an environment which encourages transparency and continuous quality improvement activity that will benefit our patients, as well as our staff."
To learn more about the Institute for Healthcare Improvement, visit their website at Visit NVRH’s website at

Contact Information:
Hilary De Carlo
Marketing Manager