By Lauren Johnson
Within a one-year time span, Children’s of Alabama enhanced their patient experience in the emergency department through operational improvements and upgrades in the waiting room, leading to an increase in satisfied patients, a higher net promoter score and a lower Left Without Being Seen rate.
After making these changes, the Children’s of Alabama Emergency Department ranked first among 24 pediatric emergency departments using net promoter score as a metric and received NRC Health’s Excellence in Patient Experience – Pediatrics Award for 2023-2024.
Beth Rocker, the vice president of patient experience, witnessed the gradual success of enacting these changes, and through her position, she’s continuing to help maintain it.
“We wanted to take the opportunity to highlight some of the great work our teams, specifically in our emergency department, have been doing the last few years,” Rocker said. “We saw a great improvement in our feedback following these new interventions, so we wanted to share it.”
In partnership with NRC Health and Beryl Institute, Children’s of Alabama collaborated in a case study to show what the emergency department did to improve these scores and to show the data results. NRC Health assisted on the front end as a strategic partner, helping Children’s of Alabama think about ways to improve the patient experience, and Beryl Institute conducted the study and reviewed and compiled the results.
Prior to 2023, the emergency department recognized several critical challenges. First, the patient experience scores were below target, and second, the Left Without Being Seen rate was above the organization’s goal.
“These two were the primary things that we were looking at. That impacted patient safety, staff morale and our organization’s reputation,” Rocker said. “Then our Left Without Being Seen rates also posed financial implications and a risk for delaying attention for patients who need emergency care. Those were the primary drivers that we were looking at to address.”
To fix these challenges, Children’s focused on evaluation and goal setting, surge planning, facility improvements, integrative care solutions and staffing enhancements. First, the ED made sure they were measuring the evaluations appropriately through simplified surveys. Then goals were set by an interdisciplinary committee including physicians, nurse practitioners, registered nurses, clinical assistants, respiratory therapists, registration staff, volunteer services, certified child life specialists, social workers, patient relations and chaplains.
Next, the emergency department worked on surge planning and opened other surge areas so the facility could see more patients. The ED performed practice drills using the new surge spaces, paired float nurses with providers and collaborated with house supervisors to optimize patient placement.
To improve the facility, the hospital revamped the ED by adding sensory friendly spaces in the waiting room and exam rooms. TV’s were also installed in the triage room and updates were made to the SANE exam room.
“We wanted to make waiting a little more comfortable for families in the emergency department. We added a book vending machine, which has been a big hit for the kids. They get to select a book and read it during their wait, and take it with them,” Rocker said.
With the volunteer team and social work team, the ED worked on integrative care solutions and created a Care Cart, which includes hospitality items, activities and meal vouchers. Volunteers bring the cart around the waiting room to support the patients and families.
Staffing was also enhanced by increasing the number of volunteers, expanding volunteer responsibilities, increasing staffing capacity, hiring more RN FTEs and introducing flexible shifts.
According to Beryl Institute’s research, Children’s of Alabama Emergency Department improved its net promoter score (NPS) by 12.8 percent to 78.1, which is well above the national average NPS of 55.6. These scores come from the feedback that patients and families give the hospital after their visit, including their likelihood of recommending the facility to others.
In the surveys, the ED also asked patients for feedback on communication, and Beryl Institute found that good communication score increased by 4.3 points within the year time span, making a score of 72. Additionally, the Left Without Being Seen rate dropped from four percent to 1.7 percent.
“Our Left Without Being Seen rate was the lowest rate that we had seen outside of the COVID years, which was just phenomenal. More patients are being seen in a timely manner,” Rocker said. Children’s of Alabama Emergency Department sees an average of about 200 patients per day.
Rocker and the Children’s of Alabama Emergency Department plan to continue evaluating the patient experience and environment and making enhancements where needed.
“Patients come to us for medical care, but we want to go above and beyond that and make sure that we’re meeting their holistic needs, and meeting them where they are,” Rocker said. “We’re working to make sure that these things are continued and expanded upon as we move forward.