A Pediatric Emergency Department at Lynchburg General Hospital

Abstract

The emergency department (ED) at Lynchburg General Hospital (LGH) was operating at well over its capacity, and too many patients were leaving without being seen by a doctor. Chris Thomson, chairman and medical director of the LGH-ED, was charged with bringing the numbers back on track, and he began by ramping up the ED's Lean program. Thomson and the ED's new process engineer, Jennifer Stowers, set out to enhance quality, service, and efficiency while standardizing and streamlining all processes to make the ED more efficient in every way. They also felt strongly that creating a new pediatric ED would be beneficial. But would the hospital as a whole be receptive to the changes Thomson and Stowers were proposing? This case has been used in Darden's course elective “Management of Service Operations.” Excerpt UVA-OM-1523 Jan. 27, 2015 A Pediatric Emergency Department at Lynchburg General Hospital The emergency department (ED) at Lynchburg General Hospital (LGH) was the primary site where Centra Emergency Services Group (CESG) practiced. CESG was an employed-physician group comprising roughly 40 emergency-medicine physicians and 15 advanced-practice professionals. In 2010, when he was promoted to chairman and medical director of the LGH-ED, Chris Thomson, MD, would oversee system-wide emergency services at both LGH and Southside Community Hospital (SCH) in Farmville, Virginia. The LGH-ED serviced around 95,000 patients per year, and SCH-ED around 30,000 patients, bringing the combined total to 125,000 ED visits per year. The two EDs recorded $ 217million in charges and $ 89 million in collections annually. Thomson was charged with enhancing quality, service, and efficiency while standardizing all processes during an important transition from a single-hospital practice to a multisite practice serving an integrated hospital system. Exhibit 1 provides details about LGH. Prior to 2007, CESG was a democratic, independent physician practice called Lynchburg Emergency Physicians (LEP), but in 2007, LEP was dissolved and the physicians became employees of Centra Health. CESG spent the years 2007 to 2010 transitioning to this new employment model. Once the model was stable, attention turned to developing the system-wide, multisite practice. Integrating the groups, processes, and physician standards was part of the challenge that Thomson took on in 2010. . . .