Smarter collaboration allows the ED at Adrz hospital to cope with peak volumes

Philips helped Adrz hospital develop new processes and work agreements in their emergency department (ED). 


Peaks in workload cannot always be avoided — particularly in the emergency department. At Adrz hospital in Goes, the Netherlands, the emergency department realized that simply working extra hard did not provide a structural solution for dealing with these peak times. They collaborated with consultants from Philips to establish and agree upon new ways of working to keep the workload manageable.

If a blockage occurs somewhere in the team, it is not necessarily the fault of that one colleague – the whole team can take the responsibility to organize things differently.”

Alberdien van Kooten, specialist ED-ICU nurse


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The emergency department (ED) at Adrz hospital provides care to patients with acute medical problems which general practitioners cannot treat. The department's unique, central location in the Zeeland province of the Netherlands makes it an important site when it comes to acute care accessibility. Given this position, Adrz's strategy is that the ED should always remain open.

The challenge


However, the department faces a challenge – a shortage of experienced, specialized staff. In order to provide continuous care, the department understood they must work smartly and efficiently. Philips consultants helped to optimize the ED to properly handle patient flow during peak periods.


Two peaks a day

Adrz patient intake typically peaks twice a day. At these busy times, it is not always possible to schedule a sufficient number of qualified staff. The tendency in the ED was to work harder as the waiting room became more crowded. 

ADRZ Results

"Our triage nurse in particular was often overloaded," says Alberdien van Kooten, specialist nurse for the ED-ICU. "The nurse had to manage the waiting room, as well as coordinate calls with ambulances. If the waiting room was full and many new patients were arriving by ambulance, things started to build up. In this situation, some patients had to sit in the waiting room for far too long."

Our approach


Philips consultants collaborated with Adrz hospital to address this challenge by setting up a steering committee consisting of doctors, nurses, team leads, and doctor's assistants. An analysis at the start of the project showed that there were two solutions with the highest potential for improvement: reshaping the way work is coordinated in the ED and refining and renewing work agreements. 


A new way of working to improve efficiency

Together, the steering committee and Philips consultants designed a new way of working to improve the ED flow. Van Kooten explains the new approach, "The triage nurse no longer has any contact with patients and instead solely has a coordinating role. Additionally, we only triage when direct bedding is no longer possible. Patients who are not given a bed immediately are now approached by a doctor or nurse, so even if they have to wait a little longer and cannot be helped instantly, there is still someone there to listen to them. That makes a huge difference to the patient's experience."


The next step was to train all nurses to work according to the new job profiles. The aim of the training was to enable nurses to perform their role more uniformly. In addition, the team learned about communication strategies to help guide their colleagues more effectively.



This different way of working resulted in a 22% increase in direct bedding, i.e. patients who could go directly from the waiting room to a treatment room without being triaged in a separate room first. The average time patients spent in the waiting room decreased by 21% (from an average of 18.5 minutes down to 14.5 minutes). The turnaround time was further shortened by 5 minutes per patient1


Renewed work agreements in the ED

An analysis among ED staff also showed that many existing work agreements were not known or recorded in the same way by all team members. The steering committee, together with Philips consultants and a delegation of doctors, nurses, and doctor's assistants, collaborated to define new work agreements, including dealing with emergencies at the counter, requesting examinations, and performing minor surgical procedures. 


"The work agreements are now much clearer," says van Kooten. "For example, we have an agreement that patients who are referred from the ED will be admitted within twenty minutes and that lab results will be received within an hour."


Not all work agreements were able to be addressed in one session. Therefore, Philips consultants developed a Work Agreements Toolkit, which team leaders will use to independently organize their own sessions to discuss future work agreements.


External help

The collaboration with consultants from Philips was a positive experience: "We realized that the workload was too high and that patients sometimes had to wait too long,” says van Kooten. “In cases like this, it’s good to get external help to take a close look at how you do things, as this will give you new insights. Together you can review and determine what exactly you need to do to tackle this kind of issue. And, if a blockage occurs somewhere in the team, it is not necessarily the fault of that one colleague – the whole team can take the responsibility to organize things differently. It is frustrating for everyone when the waiting room is full of unhappy patients and there are four ambulances pulling up to the door."

It’s good to get external help to take a close look at how you do things, as this will give you new insights.”

Alberdien van Kooten, specialist ED-ICU nurse


1Data on file with Philips

*Results from case studies are not predictive of results in other cases. Results in other cases may vary.

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Adrz is a general hospital with locations in Goes, Vlissingen and Zierikzee in the Zeeland province of the Netherlands with 2,100 employees, 220 medical specialists and 160 volunteers. Besides general care departments, the hospital has a large emergency department that is important for providing acute care in the region. Adrz works with general practitioners and other health organizations to improve the quality and efficiency of healthcare. 

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