MedStar Health Emergency Department (ED) associates shared ideas to improve the MedStar ED experience.
MedStar Emergency Physicians and MedStar Institute for Innovation’s (MI2) Innovation Challenges team, in partnership with MedStar Risk Management and MedStar Nursing
MedStar Health hospitals have received more than 450,000 ED visits in a year, according to fiscal year 2018 data.
Two questions were at the heart of the MedStar Health Emergency Department Internal Innovation Challenge:
MedStar Emergency Physicians co-sponsored the Challenge with the MedStar Institute for Innovation (MI2), MedStar Risk Management, and MedStar Nursing, selecting two team submissions for implementation.
In March 2019, the Challenge invited MedStar associates whose main job responsibilities focus on the ED—including nurses, physicians, advanced practice clinicians, techs, security, social workers, and support staff—to submit ideas individually or in teams that would improve care.
More than 50 ideas were submitted online, summarizing the problem, solution, value proposition, metrics, and barriers. The Challenge Steering Committee then identified 25 semifinalists for inclusion in a process that crowdsourced finalist selection to all ED staff. Via an online survey, each ED associate could cast up to 10 votes for the ideas they thought had the greatest potential; nearly 1,500 votes identified eight finalists.
In April 2019, seven finalists each presented a 4-minute pitch of their idea followed by a 4-minute Q&A to a panel of judges and other attendees at the MedStar Innovation and Design (MIND) Lab.
The judges selected two winners:
It’s 2019, and we read a medical record number (MRN) on the phone to admit a patient? A hospitalist communication system for admissions
Carolyn Phillips and Michael Yacovelli; MedStar Washington Hospital Center and MedStar Georgetown University Hospital; Emergency medicine resident and attending physician team
When ED providers seek to admit their patients into the hospital, they communicate with the hospitalist team: a group of internal medicine providers who care for patients solely while they are in the hospital. Despite electronic health record (EHR) and text messaging technology, however, the current process requires ED providers to page the admitting hospitalist without any information about why they are paging. Basic patient information (e.g., patient name, MRN, medical history, presenting chief complaint, and pertinent lab) that is already available in the EHR must be communicated over the phone. This idea envisions leveraging technology that facilitates communication between hospitalists and the ED providers—so the hospitalists can better review cases before responding to ED providers. The team is exploring the short- and long-term technology and workflow solutions, including use of pre-existing EHR orders for hospitalist consults, automatic messages to hospitalists to flag these consults, and an integrated mobile secure messaging app.
Less PercoceT and more PT: The MedStar Health Urgent Physical Therapy Program
Munish Goyal, John Brickley, Lindsay Batson, and Liz Delasobera; MedStar National Rehabilitation Hospital, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, and MedStar Health Urgent Care; Physician and physical therapist team
Patients commonly turn to EDs and Urgent Care sites for management of their soft tissue injuries (e.g., ankle sprains). They are often prescribed pain medications and advised to follow up with their primary care doctor, orthopedist, or podiatrist for an appointment at a later date. Alternatively, this winning idea proposes that emergency providers prescribe early physical therapy, which optimally includes an appointment within a day, to strive for benefits such as reduced inflammation, targeted strengthening, neuromuscular re-education, reduced pain, less medication (including opiate) use, and faster and safer return to function. However, it’s difficult for many emergency providers to make a warm handoff to a physical therapist due to access issues and uncertainty with insurance requirements. The team proposes building a seamless, comprehensive system to ensure quick patient access to physical therapy. The solution includes providers placing an order for physical therapy in the EHR and the ability to send one email to MedStar central scheduling to manage the one-day referral and insurance needs. The team also envisions working with MI2’s MedStar Telehealth Innovation Center to ensure a telehealth physiatry visit, with the physical therapist mediating that telehealth appointment between the patient and physiatrist.