Reorganizing the accident and emergency unit 

La Mission nationale d’expertise et d’audit hospitaliers, or MeaH for short, was created in 2003 as part of the French Department of Health’s Plan Hôpital 2007. Endowed with an annual budget of 13 million euros, its mission is to help public and private hospitals improve their organization.

The MeaH targeted a select range of hospitals, and chose and financed consulting companies to support these hospitals’ efforts.

To date, MeaH has tasked Agamus Consult to audit and consult the emergency units of 15 hospitals throughout France, including the private hospital Hôpital Privé d'Antony, HPA for short.

The HPA’s parent company is Générale de Santé, a group that runs 170 facilities sited mainly in France, though some are in Italy. The HPA provides 395 beds.

Set up in 1991, the hospital’s emergency unit has been seeing a growing number of patients in recent years, treating 36,000 in 2005 and 40,000 in 2006.

Though IT technologies had supported both the station’s administrative and medical efforts, the processes largely remained the same when these systems were introduced. Three head doctors, four nurses, one orderly, and two secretaries were tasked to handle 120 cases a day.

The goal was to upgrade the emergency unit to handle emerging challenges. The emergency unit’s medical superintendent, supported by the hospital’s management, launched a reorganization project to shorten ER (emergency room) stay time and create a quality assurance benchmarking system (Tableau de bord).

Agamus Consult conducted a three-month analysis encompassing observations, consultations with staff, and process analyses. We discovered that the time spent by patients in the ER had increased by almost an hour since the last audit in 1997. This confirmed that urgent action was required.
 
The design and layout of this department’s examining rooms were suboptimal. The same goes for the organization of personnel during the hours of 12 noon to 3 pm, when patient traffic is generally highest and departments supporting the ER (such as the lab) are at their busiest.

Two measures to accelerate processes improved the interfaces between the ER and supporting departments, that is, the lab and patient registration. Accelerated lab analyses now provide results faster, and reception is able to assign beds faster to inpatients leaving the ER.

The test phase for the reorganized ER kicked off at the beginning of May. It entailed forming two-person teams to expedite the workflow. The medical teams comprised one doctor and one nurse, and the admin teams comprised one receptionist and one consultant.

After making minor changes to remedy problems pinpointed during the test phase, and various consultations with nurses and doctors, the new organization was running smoothly by the end of October. During this time, we worked with the doctors to develop a benchmarking system for quality assurance and define key indicators.

The average ER stay time was shortened by 25 minutes, with the initial waiting time dropping from 22 to nine minutes. What’s more, this was achieved with practically the same size workforce and over 10% more patients. With faster treatment times and faster diagnostic support resulting from lab processes improved by new tools, the medical “value-add” was first stabilized and then slightly improved. The benefits of the new organization and improved daily routines have convinced the entire team.

The unit continues to rely on the benchmarking system with eight composite indicators to gauge compliance with procedural standards, process quality, and the satisfaction of patients and their families.

Didier Stéphany, Agamus Consult