ETMC Athens gears up for next flu pandemic

Throughout the month of September, East Texas Medical Center, Athens (ETMC Athens) saw a 42% average surge in number of patients per day due to publicity of the H1N1 virus and took it in stride. Improved efficiencies in the Emergency Department facilitated by a process improvement firm, Compirion Healthcare, allowed the hospital to absorb the volume and still see an improvement in quality.

Many other Texas hospitals were caught off-guard and resorted to setting up triage tents and drive-through treatment centers to deal with the influx of cases related to the H1N1 virus. Since April, forty-four people in Texas have died from the H1N1 virus.

Because of the foresight of ETMC, Athens CEO Pat Wallace, Compirion Healthcare Solutions, from Elm Grove, Wisconsin, had been brought in five months earlier to conduct a process improvement project throughout the Emergency Department. Hospital Administration wanted all of its process flow issues addressed and fully implemented before construction began on its new, larger Emergency Department, scheduled to break ground in January 2010. Also in the agreement, Compirion was to develop a Surge Capacity Plan to handle increases in volume from H1N1 cases until the new facility is completed in January 2012.

For the last two years, ETMC Athens leadership had been working on a Surge Plan in the event that capacity in the Emergency Department would exceed its ability to safely treat patients before the ED expansion could be built. The ETMC Athens Emergency Department currently has 15 beds. The new Emergency Department will have 22. After Compirion was engaged, the Surge Plan was added to its list of responsibilities. Compirion and the ED staff returned with a Surge Plan within three weeks.  

The Surge Plan took a proactive approach. Additional space was created and five rooms were added on a temporary basis by utilizing some vacant rooms outside of triage and relocating the offices of a department director and coordinator. The ICU waiting room can also be occupied on a temporary basis and turned into two exam rooms. Carts stocked with supplies were added to the new rooms. The plan called for staffing by one MD and one new RN, in addition to the Triage Nurse already stationed in the area. Computer access could be achieved using laptops. The hospital was given formulas and predictive patient visit models for determining when the Surge Plan would be engaged. In the event of a surge, a group identified as the "Call-Back Six" were put "on call" to help until the volume becomes manageable again. The "Call-Back Six" consist of an ED Tech, an RN, a Discharge RN, a Registrar, a Radiology Tech and a Lab Tech.

"It was great timing to have Compirion here to help us before the volume hit. It was busy, but the good news was the workflow redesign made the increased volume tolerable and workable; otherwise, it would have been a disaster. We made our processes parallel instead of linear. This was a huge achievement," said Rebecca Powell, Chief Nursing Officer.  

Medical Director for the Emergency Department, Dr. Daniel Bywaters added, "I shudder to think what would have happened if our friends from Compirion hadn't been here. Now it is busy but not as difficult as it was before Compirion came. It is much better, even at these volumes, now that our process has improved. I am very appreciative that Compirion has helpful, courteous, hardworking and effective people. They have been a pleasure for me to work with."