TeamSTEPPS Helps Arizona Hospital Reduce Emergency Department Wait Times

Prior to 2015, patients waited an average of nearly 90 minutes for treatment at the emergency department (ED) of Banner Payson Regional Medical Center, Payson, Arizona. While Banner Payson had earned high rankings for some clinical services and had been designated as one of the Nation’s top 100 hospitals three times by Thomson-Reuters, wait times at the central Arizona ED were high on the list of issues demanding a top-to-bottom overhaul, according to hospital officials.

To improve performance, the facility used a combination of operational improvements and TeamSTEPPS® training to reduce the hospital's ED wait times from a high of 89 minutes in April 2015 to an average of 18 minutes in April 2016, according to Banner Payson CEO Lance Porter.

Banner Health, a Phoenix-based non-profit system with 29 hospitals, acquired the 44-bed hospital from Community Health in 2014. Banner Payson suffered from problems with communication among physicians and nurses, a lack of teamwork and accountability among staff, and a general culture that shunned new approaches to familiar problems, according to Porter. For example, input from the nursing staff was discouraged by the former ED physician group, increasing the risk of delays and poor outcomes, he noted.

To begin addressing the ED's problems, Banner Payson brought in the national ED staffing firm TeamHealth, which recommended using AHRQ's TeamSTEPPS training program. Developed in collaboration with the Department of Defense, TeamSTEPPS is an evidence-based patient safety system used worldwide to improve communication and teamwork.

Banner Payson also introduced several operational fixes to help improve efficiency. These included hiring scribes to input notes into electronic health records for physicians, allowing nurses to order routine lab and blood tests, and shifting schedules to make more providers available during peak times. Using ED technicians during busy summer months also helped reduce waiting times. Together, these changes began to move the ED into performing in a more efficient manner, according to Porter.

"The real achievement is the change of culture" that occurred as a result of the TeamSTEPPS training, Porter noted. One tool known as a huddle, where physicians and nurses meet at the end of every shift to share patient information, has been a notable teamwork booster. Physicians use huddles to discuss with nurses why they’ve chosen a certain clinical protocol, encouraging nurses to be actively engaged in the care plan.

"Nurses are doing more than checking a box or keeping score," Porter explained, adding that "they feel part of a team, and they have that sense of urgency."

Maintaining a culture in which teamwork and communication are valued is an ongoing challenge to many organizations, and one that Banner Payson has anticipated. To maintain the momentum, all ED staff are involved in teams that address how to continuously improve patient information-sharing so that patients have a personal stake in the process, Porter explained.

Making sure that new hires are committed to a teamwork-oriented environment is another priority. "We only want people who fit the new culture," Porter said. "Luckily, we have enough staff interested that we don't have to settle for less."

In a related effort, the hospital is forming a team to review admission delays and determine how to admit patients more efficiently.