How Baptist Health in Arkansas reduced ER boarding

It’s a common problem at many hospitals: patients staying in the emergency department, waiting for hours, or days, for a room.

Baptist Health in Arkansas, which operates 12 hospitals, has been finding success in reducing congestion in the emergency room, a problem often called boarding.

With the use of predictive AI and the buy-in from doctors, nurses, and other staff, Baptist Health has decreased boarding by about 525 patients each month, says Greg Brown, associate system vice president for Baptist Health, Arkansas.

Brown oversees the patient command center that’s helping move patients through the emergency department more quickly and improving throughput across the system. In an interview with Chief Healthcare Executive®, Brown says the system is getting patients the care they need more quickly and improving the ability to take in more transfers.

“I think every hospital probably in the country struggles with ED boarding,” Brown says. “You know, I think one of the challenges that we have to really think about is ED boarding is really not an ED problem for the majority of cases. It really has to do with bottlenecks, inefficient processes, lack of flow within the medical-surgical and the ICU units to help relieve some of that pressure.”

Brown acknowledges that it has taken some work, but the results are encouraging.

“The proof is in the outcomes,” Brown says.

“We can go across and we can look at all of our outcomes from our discharge processing time to our orders before 9:00, to the hours and the time when the patients that are going through our discharge lounge, the number of boarders decreased,” he says. “All of those things we can take to our leaders across the system and say, here is proof of the execution and the work you've done. And it just makes a world of difference, because at the end of the day, it's all about the patient.”

‘Information that is actionable’

Baptist Health partnered with LeanTaas, a healthcare technology company, to help improve the patient flow in the emergency department and across the hospital.

The health system is utilizing AI-powered predictive analytics to identify patients that could be ready for discharge early, helping make more beds available for those waiting in the emergency room. Now, the system is seeing more discharge orders coming in before 9 a.m., allowing most patients to be discharged by 11 a.m.

“It gives us that capacity when we know that patients are really going to start coming into our hospital in the afternoon hours,” Brown says.

He says it’s not just about giving staff more information, but providing more actionable data for frontline teams to overcome barriers.

“We've been able to recoup without building brick and mortar, without doing anything significantly around improvements of the infrastructure,” Brown says. “But really it's about improving processes that give us what we call bed time back to our emergency department to decrease the number of boarding hours and the number of boarding patients.”

In addition to identifying patients that could be candidates for early discharge, Brown says Baptist Health is using data to see if there are patients who may have barriers that could be addressed to ensure the patient can be discharged promptly and safely.

“It's not just getting information for information's sake; it's really providing information that is actionable in the moment,” Brown says. “I think that's where we've seen probably the biggest opportunity for us to be very successful.”

‘The culture shift’

While Brown says technology is providing more useful insights, he says the culture change within the system has also been an essential factor in the gains Baptist Health is seeing.

He says part of the motivation is to help staff understand that larger health systems such as Baptist Health are seeing more patient transfers from smaller hospitals, a trend he expects to continue.

But he also stresses that the system is asking staff to work smarter.

“Instead of asking our folks to work harder, which I think historically has been the norm across healthcare … It's really about how do we remove friction and barriers and make that process much easier for us to navigate,” Brown says. “And so it's really not working harder, it's working more efficiently. And when your team sees that and they can feel that pressure relief and it allows us to do more with less, then I think that culture changes on its own over time.’

“The culture shift and really understanding how we get the information to the providers, and then for them to trust that information that we're providing them, has been a key for us,” he says.

Baptist Health rolled out the system-wide tool slowly, beginning with a couple of hospitals. The system looked at metrics and also ensured that there was sufficient support from staff.

Staff came in with suggestions for improvements.

“It really wasn't fully, we're pushing information, pushing, pushing,” he says. “It became a partnership between all the parties that were involved in looking at, how can we truly make this better?”

“It really became a true partnership from all aspects across our healthcare system,” he says.

Create a strong governance plan

Doctors and nurses played a critical part in the development of the new system, Brown says. He says physicians, nursing leaders, frontline nurses and hospitalists had built strong relationships, which enabled the process to be more successful.

While key leaders were brought into the process early, Brown says the involvement of nurses at the beginning was critical.

“The nursing staff within our hospital, they're at the tip of the spear, as they say. They are the ones that really help make or break a new process,” Brown says.

“It wasn't an initiative that we developed kind of in secret and then just kind of threw out to the teams,” he adds.

When asked about advice for other health systems undertaking similar programs, Brown cites the value of perseverance and patience.

“Anytime you institute a new process that is going to maybe change the way that you've always done things is uncomfortable,” he says.

He says the most important guidance he would offer is to create a good governance structure including leaders of different components of the system, including doctors, nurses, the IT department, laboratory, radiology, and environmental services.

“Those are the ones that are going to make you successful and to really get those processes in place,” Brown says.

“It’s really just to be patient in the process, to be open and transparent,” he says. “And allow input from all components of your system to help you make it better. Because all of those in that governance structure are the ones that are really going to set the vision for your system for the years to come.”