Fairlawn FastTrack Reduces ED Stay

In September of 2017, members of Fairlawn Rehab’s executive team presented a patient flow issue to the Radiology Quality Team. Their patients who were coming to UMass [who only required imaging services] were being bogged down in the Emergency Department unnecessarily. These reports were far from anecdotal; through further data analysis, it was determined that their patients had an ED length of stay anywhere between 14-20 hours. Despite the obvious concerns, these patients were receiving duplicate medical evaluations, being treated for issues unrelated to their care at Fairlawn, were experiencing insurance denials, and were even at risk of losing their Fairlawn residence due excessive length of stay in the ED.  The timing of this conversation couldn’t have been better, given that UMass Memorial Healthcare was focusing improvement efforts on removing ED Boarders and reducing the turnaround time for imaging services in the Emergency Department.

Beginning in mid-September, a comprehensive team was assembled to spearhead an improvement project. The team included members from Fairlawn, the University Emergency Department, Radiology, Epic, Registration Staff, Finance/Billing, and EMS Services. The team would focus its efforts on ensuring a seamless delivery of imaging services without the patient having to be admitted to the Emergency Department. In initial meetings, the team applied LEAN thinking and tools by engaging in a Value Stream Mapping project. This helped to understand the actual flow that Fairlawn Patients were experiencing and also to identify WASTE and areas for improvement.

The team displayed their commitment to improvement by meeting on a monthly basis to discuss, review, and implement changes to benefit the patient. Some of the improvements include, but are not limited to:

• Patient will arrive at UMass and go DIRECTLY to Radiology (by-passing the ED).
• CT techs will prioritize Fairlawn patients and treat them as STAT requests to expedite services.
• Attending Radiologists will provide Final Report immediately after scan is completed.
• EMS will remain with the patient until a disposition is determined.
• Patient will be registered with a special billing flag to prevent them from being billed inappropriately.
• UMass will charge back Fairlawn Rehab for Outpatient Imaging services provided.

Through these improvement efforts, it was estimated that a Fairlawn patient would be able to arrive to UMASS, have imaging services completed, and have a disposition determined within 45 minutes. Compared to the initial 14-20 hour ED visit, this was a considerable improvement.

The project has been given the nickname Fairlawn Fast Track and went live on March 1, 2018. To date, only one patient has experienced the new flow and proved that the improvement efforts were an ultimate success! The team will continue to meet on a monthly basis to re-evaluate the flow and look for continuous improvement

Great work Fairlawn Fast Track team! The University Team pictured above from top to bottom, left to right Steven Beaudoin, Timothy Clark, Kathy Green, Diane Kuindersma, Kevin Reynolds, Dr. Saurabh Rohatgi, and Jason Wilder.