Connecticut Hospital Reduces Emergency Wait Time, Adverse Events Using AHRQ Tools

Bridgeport Hospital, a 383-bed safety net hospital in Bridgeport, Connecticut, used two AHRQ tools to improve care in its facility. With AHRQ’s Door-to-Doc patient safety toolkit, the hospital reduced emergency department wait times to 21 minutes, while AHRQ’s Safety Attitudes Questionnaire contributed to facility-wide improvements in patient safety culture, which led to an 86 percent decline in serious safety events.

Using Door-to-Doc, Bridgeport began categorizing patients into “less sick” or “sicker” subgroups, based upon a brief analysis rather than a full triage. The key was to keep the majority of patients—those who were less sick and ambulatory—moving through the examination process so that emergency department beds could remain available for more serious cases.

“The Door-to-Doc process provided a means of cycling patients through the emergency department predictably, so they could proceed with their evaluation and treatment by going to the x-ray area, the IV infusion area, and so forth,” said Rockman Ferrigno, M.D., Bridgeport’s chairman of emergency medicine and associate chief medical officer. “It meant that we could cycle three or four patients per hour through each bed in our emergency department,” he explained.

Dr. Ferrigno noted that it could take as long as 6 or even 8 hours for patients to be seen before the new model was implemented. Now, the emergency department wait time is just 21 minutes under a streamlined process that has enabled Bridgeport to provide care for a growing number of patients each year without expanding its building.

“We’ve been able to handle an annual patient volume in the emergency department that has grown from 60,000 patients in 2010 to 93,000 in 2017,” Dr. Ferrigno said.

Bridgeport also strengthened its culture of patient safety when its entire staff—from the receptionists to physicians to the custodial staff—began using AHRQ’s Safety Attitudes Questionnaire in 2009. [Note: this questionnaire became the Teamwork Attitudes Questionnaire in 2014 as part of AHRQ’s TeamSTEPPS program.] The survey provided a way for staff to give feedback to senior hospital executives who led safety rounds within the hospital each week.

“The senior staff safety rounds provide a cross-check for continual improvement through gaining the perspectives of various hospital staff,” said Ryan O’Connell, M.D., vice president of performance and risk management. “For example, a geriatric dementia unit nurse said her patients perceived the black tiles of a patchwork floor design as holes, and they took pains to walk only on the light-colored tiles. That was a ‘quick fix.’ We now have uniformly tiled floors, and those patients walk more steadily than before.”

“The patient rounds and the questionnaire were part of a comprehensive patient safety program launched in 2013 for measuring preventable adverse events,” he said. “As a result of those efforts, I truly believe that patient safety has become ‘top of mind’ for physicians and staff, and nurses have a greater comfort level to raise concerns with physicians without fear of retribution. We’ve found that preventable adverse events resulting in moderate to severe harm or death have dropped by 86 percent from 2013 through 2017.”  

Hospital-wide, the hospital’s culture of patient safety continued to improve. The questionnaire scores on “overall perception of safety” climbed from 45 percent in 2009 to 66 percent in 2013. By 2017, scores rose to 70 percent.  Communication and perceptions on patient safety also increased by as much as 25 percent among hospital personnel.

Another major benefit of using the questionnaire is “the strong trust that has been built between hospital leadership and staff,” said Michael Ivy, M.D., chief medical officer. “Our senior leaders may have to swallow their pride and be prepared to graciously accept negative feedback—occasionally very negative,” he said. “But ultimately, our CEO believes that this direct, regular face-to-face dialogue has resulted in many real-time improvements that have positively impacted patient safety.”