In 2004, Detroit Medical Center launched the 29-minute guarantee. Come to one of our emergency rooms, and you will be seen by a physician in 29 minutes or less. That program is still going strong, but now, with even greater accountability, with current ER wait times posted at DMC.org.
“Our philosophy was that that patients should not wait to see an emergency physician,” says Dr. Suzanne White, Chief of Emergency Medicine. “We were encountering increasing numbers of medial and traumatic conditions where what we did in the first 30 to 60 minutes made a huge difference in the patient’s outcome.”
Establishing the guarantee required a top-down approach; to make it work for the entire DMC system. Buy-in was required from every level, from CEO to all the ancillary departments, such as radiology, lab, even in-house nursing. “We really had to look at all of our processes in great detail,” continues Dr. White. “Everything from our space utilization to how we are doing our laboratory studies, our x-ray studies, our registration processes – everything was examined. We cut out areas that were wasteful and really tried to make things as efficient as possible.
Bedside registration – rather than having people wait in the waiting room at a desk to register, DMC clerks come to the bedside. By this time, the clinicians have already started their medical assessment of the patient.
Electronic Medical Record Implementation – Physicians can enter their orders into the computerized system, and immediately nursing staff and other caregivers are able to see their orders and can act more quickly. Paper charts are not carried or lost; the record is always available.
Robotic Consults – in case where a very specialized opinion is required, DMC ER doctors can bring a robot to the bedside and connect with an expert who can actually talk to and examine the patient remotely, bringing a much more efficient diagnostic point, and allowing for treatments to start much more quickly in these cases.
Beyond the treatment room, other process improvements were implemented system-wide. Laboratory streamlined their steps, allowing for some results to come back within 15 minutes. Radiology hired transporters to pick up the patients and have them ready for their tests in queues, rather than picking them up one-by-one. All these shifts required one essential factor: teamwork.
“It’s all about teamwork,” concludes Dr. White. “The most important thing for us is to be able to quickly lay our eyes and hands on a patient and be able to see firsthand how sick they are and what we need to do to start fixing the problem right away. Patients don’t like to wait. So a big part of what we do, even if the patient isn’t critically ill, is providing reassurance; that’s one of our most important jobs. The faster we do that – to reassure parents that their children are going to be okay -- is just wonderful value for them and they really appreciate it.”
To find out more about the DMC 29-minute Emergency Room Guarantee, and to see current Emergency wait times, click here.