Improve Quality and Reduce Costs

Country: Ecuador
Client: Ministry of Health
Date: 2014
Status: Complete

Project Description

A program to “Improve Quality and Reduce Costs” in large urban Ministry of Health hospitals. The programs have provided the target projects with strategic planning and follow up support to improve quality and reduce costs including utilization of Key Performance Indicators in Emergency Department Project.

  • Staff was trained on the WHO recommended Andorran Triage Model; it was implemented with ongoing educational and operational support by the consultants
  • It was determined that about 40% of patients required low complexity services, classified by Andorran Triage Process levels 4 and 5. The physical layout of the Emergency Department was reconfigured without minimal construction to include an urgent care area and increase patient flow for these patients
  • Development of an Immediate Care Center within the ED to take care of low acuity (Levels 4 and 5) patients to decompress the congested Emergency Department
  • Performance improvement tools were implemented to improve clinical encounters and increase consistency in service provision. Improved utilization has drastically reduced patient wait time with the new Triage Model, meeting the established goals
  • In November 2014 the ED was seeing over 1,000 patients a day, currently with the new redesign and Triage system they are seeing between 300 and 400 patients a day. The rest of the patients are seen in an Immediate Care Center. This has allowed the hospital to reassign personnel to other areas
  • A supply tracking system has been implemented consequently a significant cost and waste reduction is expected

What We Did

Emergency Department Process


• Reorganized physical layout of department
• Introduced an urgent care area
• Rapid triage using Andorran Model
Physician meets ambulance to triage, provide immediate care
Nursing triage
• Quick registration process
• Focused history taking
• Focused assessments / reassessments
• Charge nurse focus on:
Traffic control
Discharge and opening up beds
• Increased accountability and patient focus


• Team approach to care
Maintain consistency in communication
Reduced the number of interactions
Clear process to provide specialist care  and diagnostic services
• Adjusted provider and nursing staffing patterns to revised patient volumes


• Prioritizing discharge: Established timelines for patient transfer
• Streamlined reporting – SBAR
• Observation unit
• Limit time holds


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