Community seeing first-hand the improvements at Norton Community Hospital ED


Photo caption: Using the new Value Optimization System,
team members at Norton Community Hospital came together
to improve the patient experience in the hospital’s
Emergency Department. From left, X-ray technician
Jason Martin, Emergency Department nurse
Jane Fowler and physician’s assistant Nicole Pilkenton
confer during the planning stages.

NORTON, Va. – At Norton Community Hospital, things have really improved for patients who go to the Emergency Department.

Over the last few months, patients are being seen faster. Lower acuity patients are getting in and out more quickly. More patients are being seen.

“Some people were driving outside the county for treatment. They could do that in the time it would take to be seen here,” said Norton’s assistant administrator and chief financial officer, Stephen Sawyer. “But now they don’t have to do that. It's much quicker to stay here.

“The community is realizing, ‘Hey, we can get quality service quickly at Norton.’ ”

Why all the drastic improvements? It’s because of VOS – the Value Optimization System.

Norton was one of the first Mountain States Health Alliance (MSHA) facilities to implement VOS. Using Lean improvement techniques that were established by the Toyota Motor Company, VOS breaks down specific processes and finds ways to eliminate waste and make the processes more efficient. Since February, the hospital has held 17 Rapid Improvement Events (RIEs).

The results have been tangible and significant.Here are some examples:

  • The time from when the physician makes the admission decision until the patient is admitted into a room on the floor is down from 138 minutes to 24 minutes.
  • Patient satisfaction for the arrival portion of the ED process has increased from a score of 75 up to 90.
  • Length of stay for lower-acuity patients is down from 206 minutes to 148 minutes.
  • 100 percent of chest pain patients receive an EKG within 10 minutes of arrival, up from 56 percent.
  • The ED is treating 79 patients per day on average, up from 55.
  • Verbal handoff of patients from the ED nurse to the floor includes the patient and family in the discussion and always includes a nurse-to-nurse hand-off in person.

A big part of the improvement has come from the team’s new Express Care Process. This divided the flow of patients into two streams, so lower-acuity patients are seen by a mid-level caregiver in a different area than the high-acuity patients.

“Patients who need something simple – like a prescription, something bandaged, a throat swab or an X-ray – have a separate waiting area,” said Cristian Martin, VOS core team leader at Norton. “This allows the lower-acuity patients to get through in a quicker time and allows us to see more high-acuity patients because it frees up rooms for the more critical patients. That whole process, the standard work, was all done in one week during one RIE. And we’re still working on it to continue to make it more accommodating.”

Fewer patients now leave without being seen. And VOS improvements also resulted in offering ED patients the option of using the drive-through of the onsite HealthPlus Pharmacy to pick up their prescriptions as they are discharged. That makes it more convenient for them by avoiding another stop on the way home. The number of patients who do that has increased from 19 per week to 57.

“These changes have created great outcomes for our patients,” Sawyer said. “And we’re not done yet. We’re coming back around for a second phase for the ED. But when you have a 40-percent increase in volume like this, that’s the community speaking.”


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