Challenge
Ellenville Regional Hospital (ERH), a 25-bed not-for-profit, Critical Access Hospital (CAH) in New York’s Hudson Valley, identified a need to improve and standardize the admission decision-making process for patients originating from the emergency department (ED). ERH’s monthly ED admission (acute/observation) rate had been varied historically, ranging from a low of 2.8% to a high of 5.3%. At the same time, ERH ED transfer rate had increased from 4.8% to 7.4%, largely due to the lack of a standardized process to determine acute admissions. Additionally, an internal review of ERH transfers, revealed an inconsistent approach to transferring patients, potentially affecting the rate of admissions to ERH.
Process
The hospital engaged Stroudwater to evaluate the performance of critical workflows within the facility and provide guidance and solutions in the development of documented, evidence-based admissions criteria. ERH’s primary objective was to determine the root cause of the decline in admissions. Stroudwater worked to achieve this goal by:
1) Providing a formal framework for successful identification of appropriate patient populations and services
2) Coaching and education to transfer knowledge to the interdisciplinary team
Through the use of a self-assessment tool, key stake-holder interviews, and analysis of data and information, Stroudwater was able to identify and audit the services offered by ERH, perform a gap analysis, and explore opportunities for ERH to expand and/or improve efficiency, patient outcomes, and continuity of care. Collaboration with ERH supported the development of a Clinical Care Delivery Spectrum, designed to boost appropriate admissions, streamline processes, and improve value for the hospital.
Results
As a result of working with Stroudwater, ERH began to see an increase in admissions of patients with chest pain, COPD, pneumonia and syncope who were previously transferred who were previously transferred to a higher level of care. Retaining these patients at ERH not only increases hospital admissions but allows local patients to be treated safely and effectively while remaining near their family and community. ERH’s improved admissions was also supported by an interdisciplinary approach involving cardiology and respiratory therapy. With the support of ERH’s newly developed and implemented Clinical Care Delivery Spectrum, ERH saw a 10% increase in its ED admission rate compared to the previous year.
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