Inova Fairfax Hospital
“We made the changes we needed – budget neutral, with the personnel we had. We’re exceeding the industry standard, and we keep improving.”
- Jamaal Cottman, Crothall Director of Patient Transportation Services at Inova Fairfax Hospital
Crothall Healthcare Patient Transport Division delivers maximized value by supporting effective processes across all hospital departments, utilizing cutting-edge technology and well-trained people to optimize workflow. Inova Fairfax Hospital has benefitted from this level of service and expertise. Inova Fairfax Hospital, Inova's flagship hospital and the largest in Northern Virginia, is a 927-bed level I trauma center and teaching hospital, nationally recognized as an excellent regional medical center serving the Washington, DC, metro area.
Emergency department inpatient admission times dropped 58% in less than six months. Crothall assumed responsibilities of the Inova Fairfax patient transport department in May 2012. Crothall leaders and transport professionals worked with Inova’s business culture framework to address improved inpatient admission times in the hospital’s busy emergency department (ED).
The inpatient admission process was cut from 30 minutes to 16.5 minutes. By cutting time in the key actions of the process, 22 hours of productivity was saved.
“The work that the patient transport director and his team has done has been excellent – not only the emergency department’s throughput improvements, but also the work he has done in other departments utilizing similar strategies and seeing big improvements,” said Cheryll Battle, Assistant Vice President of Building and Support Services at Inova Fairfax Hospital.
Keeping Patients Moving
Inova Fairfax’s 78 ED beds were often above capacity, making patient throughput a priority for the administration. A centralized transport department led by Crothall provides a high level of expertise in patient transport logistics, focused oversight, safety, and service-trained transporters with metrics-driven outcomes. Focus on one process, named “ED2B” for “ED to bed,” led to a steep drop in the time of the process as well as overall admission times.
Early success began a positive chain reaction for the emergency and transport departments. This “ED2B team” is part of a larger “Patient Throughput Committee” at Inova Fairfax. Improved admission time to an inpatient bed helped lowered the number of ED “boarder” patients and “hall beds,” decreasing the probability of diverting patients to other departments or hospitals.
Crothall patient transport experts targeted CMS quality and service indicators, which directly tie back to Medicare reimbursement. CMS patient experience surveys have shown to be improved when patients have a shorter ED wait time before moving to the assigned inpatient bed. The key ED Indicator of patient disposition to inpatient bed admission, and inpatient length of patient stay (LOS) in admission can be affected by patient transport. Experts overseeing the efficient movement of patients to tests, procedures, lower-acuity units, and discharge to optimize patient flow.
The Crothall Patient Transport team fully owned the process of improvement, adding quality while subtracting wait times. “Crothall’s new process has allowed us to improve our throughput and deliver patients in a timely manner,” said Delores Gehr, Clinical Director of Adult Emergency Department at Inova Fairfax. “The process improvement plan has also helped with our patient experience scores, even during busier times.”
By the Numbers
22 hours saved in productivity as inpatient admission process dropped from 30 minutes to 16.5 minutes
58% reduction in emergency department inpatient admission times in less than 6 months
A Better Disposition
A proactive and flexible transport department lead to early success. Crothall director and Inova Emergency department nurse and physician leaders teamed up to identify the root cause of delays and created an action plan to be shared with the clinical team in the emergency department. The team utilized the expertise of the Crothall patient transport director in building data reports and analyzing the information to find opportunities and improvements.
Inova Fairfax hospitals excel in change management with A3* “Lean” principles. The immediate response to transport required nurse and patient readiness, avoiding the batching of requests and ensuring the optimal use of transporters during ED peak admit.
Moving Further Forward
Improvements did not stop at the first concept. Enhanced communication, better technology, and direct partnership with ED leaders helped prioritize transports for overall patient throughput. This resulted in an immediate drop in average time from ED patient disposition to inpatient admission. “With a centralized patient transport system, you have efficiency and flexibility to utilize staff with the right people in the right position at the right time,” said Cottman.
The project team is constantly engaged in considering a further improvement. “The team has worked very hard and is still meeting consistently to make sure the process remains the best practice for Inova Fairfax,” said Ernest Hodge, Senior Director of Building and Support Services for Inova Fairfax Hospital.
Driving patient throughput from the ED department is critical to hospitals. Crothall’s expertise in patient transportation management goes beyond technology and software to ensure results for our client hospitals. It’s about accountability, analytics, logistics, and performance.