Wellmont CEO gives tips on improving ER satisfaction

Rick Wagner • Mar 17, 2008 at 12:00 AM

KINGSPORT — Improving patient satisfaction scores at emergency departments requires a change in the way emergency departments operate and employees interact with patients and each other, Wellmont Health System’s Dr. Richard Salluzzo says.

Judging by Press Ganey patient satisfaction scores, such changes at Wellmont’s Holston Valley Medical Center have rocketed it from the bottom of the heap to near the top of patient satisfaction.

Salluzzo and officials of a Tupelo, Miss., hospital Monday via the Internet gave tips to colleagues nationwide on how to rescue emergency departments from near the bottom of the heap in patient satisfaction.

Salluzzo said the ED “starts in the parking lot” with a clean area, greeter and offer of valet parking, all of which are available at Holston Valley.

Chuck Stokes, president of North Mississippi Medical Center in Tupelo, and Wanda Della-Calce, emergency services service line administrator at NMMC, reported an increase in patient satisfaction scores similar to Holston Valley’s.

NMMC, a 650-bed regional referral center in Tupelo, is the largest hospital in Mississippi and the largest non-metropolitan hospital in America.

The three participated in a webinar conducted by HealthLeaders Media and viewed by health care leaders and officials nationwide. HealthLeaders is a monthly magazine.

“You just can’t beat your chest and say you have a great emergency department,” said Salluzzo, an emergency room physician and president and CEO of Wellmont since November 2004. “You can’t manage what you can’t measure.”

Both systems changed the “culture” of their emergency departments — including improving communications and working relationships between ED physicians and nurses and other hospital doctors and nurses. The Tupelo officials cited employee perks and financial rewards for meeting performance goals.

The Tupelo system went so far as to take out a full-page newspaper ad saying the ED there was broken and the hospital leaders were publicly vowing to fix it.

“Eventually, everybody is on board,” Salluzzo said. “If we ever tried to go back to the old way of doing things, these same physicians who initially opposed us would revolt.”

Salluzzo said that since he joined Wellmont, the system has gone from in the low 20 percent range in the Press Ganey patient satisfaction scores to more than 90 percent.

For the fourth quarter of 2007, the scores were 96 percent at 544-bed Holston Valley and 64 percent at the 348-bed Bristol Regional Medical Center, which is undergoing a 20,000-square-foot expansion of its emergency department. The February scores were 99 percent at Holston Valley and 90 percent at Bristol.

That means among similarly sized facilities, they were in the top 1 percent and 10 percent, respectively.

Holston Valley has about 90,000 ED patients a year, while Bristol has about 75,000.

At Bristol Regional last year, 99 percent of patients began receiving care in 25 minutes or less, and 90 percent saw a physician in 40 minutes or less. At Holston Valley last year, the average time it took for a patient to see a provider in the ER was 28 minutes, with 5 percent of patients sent to the ER waiting room.

“You’ll never have every matrix you need, but you’ve got to start somewhere,” Salluzzo said.

As an example of how bad it was, Salluzzo said that shortly after he came to Wellmont, a kidney stone patient in pain waited upwards of three hours at Holston Valley before getting to see a doctor or getting treatment.

Salluzzo said that wait time was unacceptable.

“Nothing good ever happens in the emergency department waiting room,” Salluzzo said.

He said studies have shown ED patients want the staff to care about them as a person; to be informed of delays; not to have to wait long to see a doctor; for the hospital to keep friends and family informed; for their pain to be controlled; nurses who show concern for their well-being; and doctors who show concern for their comfort.

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