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Fort Worth Hospital Uses Innovation and Teamwork to Drive a Wildly Successful Emergency Department

By Shari Welch, MD, FACEP | on May 12, 2016 | 2 Comments
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The emergency department at Texas Health Harris Methodist Hospital in Fort Worth is a different breed of emergency department. This can be felt upon entering the beautiful facility through the patient entrance. The greeter area is a stunning architectural space that is quiet, uncluttered, and welcoming. Filled with art and natural light (with attractive furniture on gleaming granite floors), the space is calming and invites patients to be seen. This waiting room serves more as a lobby and is meant for families, not patients. The fact that it was nearly empty every time we passed through it was testimony to the efficient operations within.

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Explore This Issue
ACEP Now: Vol 35 – No 04 – April 2016
The patient entrance/waiting room at Texas Health Harris Methodist Hospital.

The patient entrance/waiting room at Texas Health Harris Methodist Hospital.

Texas Health Fort Worth by the Numbers

  • Annual census: 123,000
  • Beds: 100
  • Admission rate: 24 percent
  • Ambulance arrivals: 30 percent

An “all hands on deck/patients first” imperative is imbedded into the culture and is almost palpable. The Texas Health Fort Worth ED has a long legacy of excellent teamwork, communication, cooperation, and overall effectiveness. The department is almost continuously trialing improvements, and this continuous “change culture” has bred amazing innovation. It has a systematic process for the rollout and trial of changes in the department that heavily involves the input of frontline physicians and staff. The ED gives almost every initiative a six-week opportunity to succeed, and as a result, they are enjoying a decades’ worth of improvement. Patient flow and workflow processes are not static. The department is always trying to improve. Some initiatives have not worked, but many have, and these changes added to the already-efficient operations in the Texas Health Fort Worth ED.

The ED boasts unrivaled performance in both clinical and operational metrics. Most of their Core Measures metrics (pneumonia, stroke, ST elevation myocardial infarction, sepsis) had performance at above 95 percent, with many at 100 percent. Further, its operational performance is unheard of in EDs seeing more than 100,000 patients a year.

Texas Health Fort Worth Performance Metrics

  • Door to doc: 20 minutes
  • Overall length of stay: 185 minutes
  • Length of stay for admitted patients: 291 minutes
  • Left without being seen: 1.4 percent

What are some of its strategies for such outstanding workflow, patient flow, and clinical quality? It begins with a very efficient intake process using traditional nurse triage. This process is abbreviated and takes fewer than five minutes with rapid bed placement. There is capacity for the triage of 10 patients at once, and though I like physician triage preferentially, if traditional nurse triage is abbreviated, resourced, and staffed properly, it can be a very effective intake model. It clearly is effective as it has been implemented at Texas Health Fort Worth.

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Topics: Care TeamCritical CareEmergency DepartmentEmergency PhysicianOperationsPractice ManagementQuality & SafetyTexas HealthWorkforce

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About the Author

Shari Welch, MD, FACEP

Shari Welch, MD, FACEP, is a practicing emergency physician with Utah Emergency Physicians and a research fellow at the Intermountain Institute for Health Care Delivery Research. She has written numerous articles and three books on ED quality, safety, and efficiency. She is a consultant with Quality Matters Consulting, and her expertise is in ED operations.

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2 Responses to “Fort Worth Hospital Uses Innovation and Teamwork to Drive a Wildly Successful Emergency Department”

  1. September 16, 2016

    Francesco Reply

    Very interesting article. I am particularly interested in knowing which technology is used on nursing carts to keep track of supply consumption. Would you be able to share this information? Thank you

  2. February 15, 2017

    Jesse Kent Reply

    I really appreciate the insight here in this post and confident it’s going to be helpful to me and many others. I’m wondering if you or anyone else has additional sources for me to read further and to be able to dig a little deeper?

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