The admission process at TriStar StoneCrest Medical Center in Smyrna, Tennessee, was taking over three hours, leaving patients boarding in the emergency department (E.D.) and slowing throughput. To bring boarding time to a minimum, the hospital utilized EmCare®’s proprietary Door-to-Discharge™ (D2D™) service with Rapid Admission Process & Gap Orders™ (RAP&GO™) evidence-based software. The technology behind the RAP&GO system has made it easy for the E.D. physicians and hospitalists to communicate about patient admissions, provide timely service and better care. In addition, by simultaneously notifying all who are involved in the admission process, RAP&GO has further helped reduce disposition–to–admit times — saving patients about two hours of E.D. boarding.

1. EMCARE® DOOR-TO-DISCHARGE™
CASE STUDY
TriStar StoneCrest placed hospital flow as a top
priority because of its significant impact on both
the patient experience and hospital performance.
Even with exceptional E.D. metrics, the hospital
faced the all too common challenges of disjointed
processes and inefficient communication between
the E.D. and the inpatient units. Learn how EmCare’s
Door-to-Discharge™ solution helped.

2. Challenge
TriStar StoneCrest Medical Center, a 109-bed HCA
hospital in Smyrna, Tennessee, near Nashville, opened
in 2003 with dedication to patient care and satisfaction.
Even with a record number of patients in 2012, the
hospital’s emergency department experiences 46,000
visits annually and has maintained an average wait
time of less than half the national average.
With the respective physicians and staff of the
emergency department and hospital medicine units
working in silos instead of focusing on a broader
picture of patient-centered care, the latent dysfunction
included:
• An average time to move the patient from the E.D.
to the inpatient unit of about three-and-a-half
hours, time wasted boarding in the E.D.
• Patients who were ready to be discharged in
the morning still filled inpatient beds well into
the afternoon leaving no open beds for new
admissions.
• Process inefficiencies, breakdowns in
communication and poor handoffs caused
wasted time and efforts.
To solve the patient flow issue, the hospital needed
an effective way to align the E.D. physicians and
hospitalists and organize the communication between
them and all those involved in the admission event.
Solution
EmCare’s Door-To-Discharge™ (D2D™) service with
Rapid Admission Process and Gap Orders (RAP&GO™)
software provides an integrated practice model that
positions the E.D. and hospitalist physicians to work
together on metrics and goals. EmCare’s RAP&GO
proprietary, evidence-based software uses InterQual*
criteria for the top ten conditions that are admitted
to the E.D. with all admission criteria agreed upon
in advance by the E.D. physicians and hospitalists at
each facility. In addition, the software expedites the
process by sending automated messages regarding
the patient’s admission status to the pager or cell
phone of the hospitalist, nurse manager, bed manager,
house supervisor and others - simultaneously.
In this case, EmCare’s D2D program, supported by
RAP&GO, helped the physicians move patients through
the admissions process with maximum efficiency.
The physicians collaborated to reduce hospital LPT/
LPMSE rates, reduce E.D. boarding time and improve
patient care quality and satisfaction while opening up
needed E.D. beds. EmCare’s RAP&GO made it easier.
EmCare is the only company in the industry that uses
this technology to improve hospital-wide patient flow.
*InterQual is a registered trademark of McKesson.
“From the first day I used it, I loved it! I can
login to any computer anywhere and get
the information I need or update the patient
status. All the calls back and forth are
eliminated. No more “Let me call you back!” –
where sometimes 30, 40, or 50 minutes would
pass before you heard back. We can now stay
ahead on beds as everyone who needs the
message gets the message at the same time.”
– House Supervisor
TriStar StoneCrest Medical Center

3. By the numbers
15%
IMPROVEMENT
35%
IMPROVEMENT
E.R. VOLUME
2011 20122011 2012 2011 20122011 2012
LWBS
00 00
15,00015,000 0.30.3
30,00030,000 0.60.6
45,00045,000 0.90.9
60,00060,000 1.21.2
Results
The before and after results from EmCare’s D2D with
RAP&GO were outstanding:
Disposition to admission (boarding time) dropped
from approximately 210 minutes to 80 minutes almost
immediately.
Additional metric improvements:
• LWBS decreased from 0.99% to 0.64%
Reduced boarding time in the E.D. meant more
patients could be seen in the E.D and patient volume
increased from 38,940 to 46,043.
-130
MINUTES
Before AfterBefore After
EMCARE’S D2D WITH RAP&GO
IMPLEMENTATION
00
60 MIN60 MIN
120 MIN120 MIN
180 MIN180 MIN
240 MIN240 MIN

4. FIND OUT MORE TODAY!
www.EmCare.com
Call: (877) 416-8079
“What makes it work so much better? There are
several factors that contribute to the efficiency.
The E.D. physicians no longer have to handwrite
the orders. With a paper system, they would
start writing the order then get interrupted –
often many times – before they could get the
order completed.
The hospitalist is paged by the RAP&GO system.
The hospitalist then logs in to RAP&GO to accept
the patient. Once the E.D. physician is notified
of the acceptance, he or she simply prints the
completed orders from the system. The system
automatically pages the house supervisor/bed
manager, charge nurse and case management
– simultaneously. So, it doesn’t take 20 phone
calls to get a patient admitted anymore. The
telephone calls have practically been eliminated.
Once the unit clerk in the E.D. has the bed
assignment for the patient, that number is
entered into RAP&GO which notifies the
hospitalist there is a patient to be seen giving
the room number, diagnosis, notes, etc. The
hospitalist acknowledges when the patient has
been seen and the cycle is complete. And if any
step in the process goes beyond the agreed time,
the notification is escalated to the appropriate
leader so that he or she can address any issues.
Any time you can write less, it saves time…. time
that can be spent on patient care.”
– Corbi Milligan, MD
Hospitalist Medical Director
TriStar StoneCrest Medical Center