Like many hospitals, Sunrise Hospital & Medical Center, Las Vegas was receiving more patients in its emergency department than it was equipped to manage regularly.
One of the largest Medicaid providers in Nevada and situated minutes from the rowdiness of the Las Vegas Strip, Sunrise was struggling with hold hours in its ED. In its worst month, the hospital experienced 28,000 hold hours, with the normal average nearing 20,000 per month, says Alan Keesee, COO, Sunrise Hospital & Medical Center.
Ever since the passage of the Affordable Care Act, and Nevada’s decision to expand Medicaid, Sunrise’s utilization of emergency services has increased double-digits each year. Last year, the Las Vegas hospital received 157,000 ED visits, the largest in the state, by far, says Keesee. With well over half of those visits attributed to Medicaid patients, he added.
Something had to be done to ease the burden on providers. Keesee says leadership saw an opportunity to streamline processes and get patients up to the floors and reduce patients’ length of stay overall.
Sunrise decided to integrate its emergency department and hospital medicine teams into one — unifying them under a single medical director.
The result was a one-team, one culture philosophy, says Keesee. The hospital’s efforts to increase the number of providers through recruitment and the development of team-based models for observational patients and protocols as part of the integration has also helped reduce hold hours.
Whereas most hospitals have their observational patients spread across the facility, Sunrise created a 30-bed observation unit, and dedicated providers and case managers to oversee that unit and monitor results, which has helped increase the number of patients discharged prior to 11 a.m. to 50 percent, up from 10. These measures have also contributed to a one day decline in length of stay for patients.
And not only have those hold hours dropped 79 percent in the ED to 6,000 hours per month, but there has been a palpable change in culture and care. One of the most noticeable changes has come from a nursing standpoint, says Keesee. Nurses now know who is on a team that day, and trust has greatly improved since having a dedicated leadership team focused on shared goals. Nurses will call and text physicians, and are able to know who their doctor is that day, says Keesee. “It’s really increased overall nursing and physician collaboration,” he added.
Keeping the momentum going and avoiding old pitfalls is always a concern after a large integration. Keesee notes that in order to keep pushing forward, leadership needs to come together to continually look for areas to collectively improve.
“You can’t do that in a silo, just the ED, just the hospitalists, you have to really have all those voices at the table, to make the improvements [and] continue to move forward,” says Keesee.
“If you’re disconnected, as an administration, with your medical leadership it’s really hard to move the organization forward with patients.”