One of 29 Hospitals Nationwide to Earn Top Improver Recognition


  About the Award

Milton Hospital is proud to announce that Press Ganey Associates, Inc. has named it a 2010 Top Improver Award Winner.

Press Ganey currently partners with more than 10,000 health care facilities-including 50% of U.S. hospitals-to measure and improve the quality of their care and their bottom line. The company's databases are the largest in the industry, and allow facilities nationwide to benchmark their results against peer organizations. This award recognizes clients who have shown continuous improvement in their patient, physician, or employee satisfaction scores-comparing quarterly scores over two years, with improved scores in three of the four eligible periods. Milton Hospital is one of just 29 Press Ganey client facilities to receive this honor in 2010.

Since opening its newly constructed, state-of-the-art emergency facilities in 2008, Milton Hospital has taken many steps to implement patient satisfaction strategies to better serve its patients. The hospital's "Journey to Excellence" program, which emphasizes ongoing improvement in quality and patient satisfaction, has been central to the development of successful, long-term improvement strategies, both in the ER, and throughout the hospital.

"Our first step was to establish an Emergency Department Task Force," said Paul Paganelli, Milton Hospital's Chief of Emergency Medicine. "This committee is an interdisciplinary team of hospital senior administrators, ED physicians and clinical staff, representatives from the laboratory, admitting, inpatient care, environmental services and other areas. Its goal is to identify problems and develop solutions by emphasizing collaboration between many areas of the hospital."

Since January 2009, wait times have been kept to a minimum, while volume growth has led to a $1.1 million revenue increase, as well as $1.2 million increase in outpatient care related to emergency room visits. The facility continually implements new mechanisms for delivering high quality care, recently introducing high-definition video technology to more easily secure a patient's breathing airway in emergency situations.

"This award is a direct result of our staff's long-term commitment to our 'Journey to Excellence'," said Milton Hospital President Joseph Morrissey. "We are so proud to be recognized by Press Ganey and even more proud of our staff who have made this achievement possible."

  How We Did It

In June 2008, construction of Milton Hospital's new emergency department was nearing completion. But escalating waits, low patient satisfaction and a staggering 12% elopement rate threatened to derail the promising future of these new facilities.

Milton Hospital focused on reducing elopement rates because it is an indicator of so many other systemic issues, including high wait times, poor communication, inefficient patient flow and lack of cooperation between departments.

A focus on reducing elopement required staff to address a list of issues that were plaguing the newly designed emergency facilities.

Emergency Department Task Force Milton Hospital's first step was to develop an Emergency Department Task Force in July 2008. Comprised of hospital senior administrators, ED physicians, managers, nurses, nursing assistants, and unit coordinators, the group convened with a common goal of identifying problems and developing solutions. The Task Force, which remains active today, demands an unprecedented level of interdepartmental cooperation and commitment, and formed the foundation for all further improvement strategies that have been implemented.

The success of the Task Force has been based on the philosophy that high quality emergency care depends upon many departments outside of the ED. Collaboration between ED staff, inpatient units, laboratory, radiology, patient transport, admitting, administration and many other areas has resulted in major positive strides in emergency care.

Bedside Registration
Milton Hospital adopted a philosophy that whenever possible, patients are moved out of the waiting room and into a treatment room as soon as space becomes available, so that emergency care can begin. Our staff then keeps the process moving by offering bedside triage, assessing and registering a patient right in their treatment room. This simple system helps get treatment started sooner.

The Resource Nurse: The Emergency Department's Traffic Controller
Often during peak times, it becomes more challenging for nurses to monitor every patient's progress through treatment. Milton Hospital instituted a new position of resource nurse to fill this responsibility.

Resource nurses are trained to create a smooth flow within the emergency department by managing daily nursing assignments, changing assignments as needed and checking for suitability of nursing skill levels. In addition, resource nurses help coordinate patient transfers out of the emergency department and into an inpatient bed. Our 30-minute goal sets an aggressive standard for transferring patients and has been made possible by way of vastly improved coordination between resource nurses, patient registration, nursing supervisors, housekeeping and emergency staff.

Since January 2009, increases in ER volume has resulted in a $1.1 million revenue increase, as well as a $1.2 million revenue increase in outpatient care related to ER patient visits. A significant portion of these increases is attributed to a dramatic deduction in ER elopements; once as high as 12%, now only 0.2% of patients on average per month leave the ER without being seen. At the same time, as efficiency and volume have increased, nursing hours per visit have remained stable, with a current average of 2.18.