CompleteCare Unites Emergency & Inpatient Physicians

EmCare’s CompleteCare Program Unites Emergency and Inpatient Physicians to Significantly Improve Performance

Bladen County Hospital – Elizabethtown, N.C.
Critical access hospital with 14,000 annual emergency department visits

Challenge
Bladen County Hospital’s emergency department had hit a brick wall when it came to progress. Patient complaints, including lengthy wait times, were at an all-time high, with approximately 4 percent of all ED patients lodging a complaint. “When I arrived at Bladen, we were receiving around 49 complaints per month in the ED, and that was just too high for me to tolerate,” says Cameron Highsmith, Bladen’s chief executive officer. 

Solution
In March 2010, Bladen turned to EmCare, the recognized leader in physician services. Specifically, the hospital sought to implement EmCare’s CompleteCare program, a combined emergency medicine and inpatient services model customized to the volume and acuity of each hospital’s specific ED and inpatient populations.

With CompleteCare, a hospital with fewer ED visits and a lower inpatient population may opt to utilize a single physician on duty in the hospital 24/7 to admit, provide subsequent hospital care and discharge patients — providing continuity of care at a lower cost than staffing physicians in each department. Higher volume hospitals, particularly on the inpatient side, could have an ED physician and a hospitalist on duty, and adjust the hospitalist’s hours according to patient volume.

“Every CompleteCare program is customized to the unique needs of the hospital,” states Jeff Slepin, MD, MBA, FACEP, regional medical director for EmCare’s CompleteCare program.
“The customization is based on the hospital’s patient volume and acuity, the available resources and service lines offered, and the hospital’s capabilities including intensive care unit and surgery.

CompleteCare is an ED service and hospitalist program where both physicians work together. The goal, according to Dr. Slepin, is to make the patient’s entire hospital experience as efficient as possible so that when patients arrive, they are seen by an emergency physician, worked up, and the decision whether or not to admit is made in a timely manner.

“Before coming to Bladen, I had worked at another hospital where EmCare had helped us coordinate the ED and the hospitalists working together to solve our common problems,” says Highsmith. “I knew that EmCare would bring in physicians who would be good ambassadors to the community and be amiable with patients, ensuring that they would have a positive patient experience.”

But Bladen’s issues didn’t end with patients. Physicians, burdened with caring for office patients and hospital inpatients, were simply getting burned out. “This wasn’t just about meeting the patients’ needs, we needed to do whatever was necessary to keep from losing physicians,” says Highsmith. “We have a small group of physicians that serve our hospital, and if we start losing them, we’re in trouble.”

With EmCare’s assistance, Bladen County implemented CompleteCare in phases, first focusing on bringing about the necessary cultural changes in the ED, including:

  • Establishing standards and training staff on interacting with patients and families
  • Developing improved communications and scripting
  • Establishing standards for patient discharge instructions
  • Implementing follow-up phone calls for discharged patients
  • Rounding on inpatients

Emergency department process changes, including front-end redesign and the use of Lean principles, were also implemented.

In January 2011, Bladen County added the hospitalist component, the second part of the CompleteCare program. The facility has a dedicated hospitalist on site 24/7/365, actively providing patient care for a minimum of 12 hours per day, and on-call at night in the hospital.

Results
Quality reports from January 2011 showed demonstrable improvement when compared to December 2010.

  • ED door-to-triage time decreased from 10-15 minutes (March 2010) to 3-5 minutes (March 2011), a decrease of 67 percent
  • ED length of stay decreased from 3.5 hours (December 2010) to 2.5 hours (March 2011), a decrease of 29 percent

The hospitalist program has also been a success, according to Highsmith. “On the inpatient side, all of our patient satisfaction results either meet or exceed the 90th percentile, and before the CompleteCare program, we’d been nowhere near that percentile,” he said.

The program has brought a sense of satisfaction and freedom to employees — a feeling that’s palpable throughout the hospital. “For one thing, physicians were previously taking calls day and night and constantly seeing patients, and they weren’t the happiest doctors in the world,” says Highsmith. “Now physicians are happier, so employee interaction is improved.

“In addition, the hospitalist isn’t seeing patients all day in the office,” Highsmith continues. “His total devotion is toward hospital patients, so the doctor is available all day to interact with staff members when they need him for new orders, etc. That makes it easier to do their jobs.”

But it’s the previously overburdened physicians who are the program’s greatest fans. “I’ve had physicians tell me that it’s wonderful to be able to have a life and not have to be constantly on call 24/7, 365 days a year,” says Highsmith. “They think this program is the greatest thing since sliced bread.”